Pathology and Etiology of 110 Consecutively Removed Aortic Valves
Tuenjai Chuangsuwanich MD*, Malee Warnnissorn MD*, Piyavadee Leksrisakul MD*, Pansak Laksanabunsong MD**, Punnarerk Thongcharoen MD**, Yongyuth Sahasakul MD***
Affiliation : * Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University ** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University *** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Objectives : To study the pathology and determine the etiology and prevalence of aortic valve disease from
surgically removed aortic valve specimens.
Materials and Methods : All the native surgically excised aortic valves (AV) received from June 1997 to March
1999 (22 months) were studied macroscopically including cuspal measurements and microscopically. By
preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of
predominant aortic stenosis (AS), aortic stenosis with regurgitation (AS-AR) and predominant aortic
regurgitation (AR). The patients’ medical records were reviewed and the clinical information was extracted.
The etiology was determined according to the macroscopic, microscopic and clinical findings.
Results : Among 110 AV (76 isolated AV and 34 with concomitant mitral valves from patients aged 15-96
years, mean age 47.54 years; male:female = 1.39:1) there were 25 AS (22.73%), 34 AS-AR (30.91%) and 51
AR (46.36%) cases. Eighty four (76.36%) were tricuspid, 16(14.54%) were bicuspid and 10 were undetermined.
Cuspal measurements of each disease were provided and compared. All AS specimens were related to moderate
to severe calcification and causes included postinflammatory disease (14 cases, 56%; age range 38-67
years, mean age 53.29years, male:female = 0.56:1), degenerative calcific change (11 cases, 44%, age range
56-76 years, male:female = 1.2:1; mean age 69 years of 5 tricuspid AV and 60.83 years of 6 bicuspid AV). In
AS-AR, 29 cases (85.29%; mean age 47.10 years; male:female = 1.23:1) were attributable to postinflammatory
disease and 5 cases (mean age 70.20 years; male:female = 1.5:1) to degenerative calcific change. In pure AR,
there were 21 cases (age range 15-65 years, mean age 29.76 years) of postinflammatory disease, 14 cases of
infective endocarditis(IE) and post IE (age range 20-63 years, mean age 42.21 years; all 10 IE cases contained
gram positive cocci), 1 case (age 55 years) of bicuspid calcific change, 8 cases of AV with dilated valve ring,
5 cases of miscellaneous causes and 2 cases of indeterminate etiology. Aschoff bodies were found in 3 AR
cases. Four of 18 postinflammatory AS-AR and 4 of 14 postinflammatory disease AR cases had past history of
rheumatic fever. One postinflammatory AS also had infective endocarditis from gram positive cocci without
clinical sign. Severe degenerative calcific change had a higher incidence of underlying diabetes (3 of 15
cases, 20%), hypertension (8 of 14 cases, 57.14%) and dyslipoproteinemia (9 of 13 cases, 69.23%) in
comparison with 3.37% (3/89) for diabetes, 9.09% (8/88) for hypertension and 30.99% (22/71) for
dyslipoproteinemia in other AV diseases in combination.
Conclusion : The three common causes of severe AV functional disorders were postinflammatory disease
(58.18%), degenerative calcific change (15.45%) and IE-postIE (12.72%). Underlying diseases of severe
degenerative calcific change included hypertension, dyslipoproteinemia and diabetes.
Macroscopic and microscopic examinations together with clinical information, echocardiographic
findings and operative details are important in evaluating the etiology of valvular diseases especially in
severely calcified specimens.
Keywords : Aortic valve, Cuspal measurements, Postinflammatory disease, Degenerative calcific change, Infective endocarditis.
