Aschoff bodies in operatively excised atrial appendages and in papillary muscles. Frequency and clinical significance

Area of Science:

• Cardiovascular Surgery
• Rheumatology
• Pathology

Background:

• Rheumatic heart disease (RHD) remains a significant global health concern, often leading to mitral valve disease.
• Aschoff bodies are pathognomonic histological findings of acute rheumatic fever (ARF).

Purpose of the Study:

• To investigate the prevalence and location of Aschoff bodies in cardiac tissues during mitral valve surgery.
• To correlate the presence of Aschoff bodies with preoperative clinical diagnoses and rhythm status.

Main Methods:

• Retrospective analysis of 481 patients undergoing mitral valve operations.
• Histopathological examination of operatively excised left atrial appendages and left ventricular papillary muscles.
• Review of preoperative clinical data, including diagnosis and electrocardiogram findings.

Main Results:

• Aschoff bodies were identified in 40 (21%) of 191 excised left atrial appendages and 4 (2%) of 273 excised papillary muscles.
• Of 45 patients with Aschoff bodies, 44 had mitral stenosis; only one had pure mitral regurgitation.
• The majority (84%) of patients with Aschoff bodies were in sinus rhythm.
• Only one patient showed perioperative signs of acute rheumatic fever, though 58% had a history compatible with ARF at some point.

Conclusions:

• Aschoff bodies are frequently found in left atrial appendages of patients undergoing mitral valve surgery for rheumatic heart disease.
• The presence of Aschoff bodies in these tissues may indicate chronic rheumatic changes even in the absence of acute rheumatic fever symptoms.
• Histopathological examination of surgical specimens can aid in diagnosing the underlying etiology of mitral valve disease.