Heart valves - Revision history

Michael: /* Rheumatic heart disease */ split out

2016-07-26T01:14:53Z

Rheumatic heart disease: split out

← Older revision		Revision as of 01:14, 26 July 2016
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	=Infective conditions=		=Infective conditions=
	==Rheumatic heart disease==		==Rheumatic heart disease==
	~~:''Rheumatic fever'' redirects here.~~		{{Main\|Rheumatic heart disease}}
	*Abbreviated ''RHD''.
	~~===General===~~
	*Classically leads to mitral valve stenosis.
	**Rheumatic fever accounts for 99% of mitral stenosis.<ref name=Ref_PBoD594>{{~~Ref PBoD~~\|~~594}}</ref>~~
	***Caused by ''Streptococcus pyogenes''.<ref name=pmid18306530>{{Cite journal \| last1 = Chopra \| first1 = P. \| last2 = Gulwani \| first2 = H. \| title = Pathology and pathogenesis of rheumatic heart disease~~. \| journal = Indian J Pathol Microbiol \| volume = 50 \| issue = 4 \| pages = 685-97 \| month = Oct \| year = 2007 \| doi = \| PMID = 18306530 }}</ref>~~
	*Disease less frequent today - as streptococcal pharynigits is treated.

	~~===Gross===~~
	*"Fish-mouth appearance".
	**Slit-like morphology; elliptical cross-sectional flow area (mitral valve) has an abnormally small semi-minor axis<ref>URL: [http://en.wikipedia.org/wiki/Ellipse http://en.wikipedia.org/wiki/Ellipse]. Accessed on: 13 November 2010.</ref> axis due to valve thickening.
	**Image: [http://www.principia-eng.com/services/construction/IMG_3098.jpg Fish-mouth appearance - pipe (principia-eng.com)].
	*Significant valvular thickening.
	*Thickening and shortening of the cordae tendinae.

	~~DDx:~~
	*Thickening of the cordae tendinae due to micronodular [[cirrhosis]].<ref name=Ref_AoGP25>{{Ref AoGP\|25}}</ref>

	~~====Images====~~
	~~<gallery>~~
	~~Image:Rheumatic_heart_disease,_gross_pathology_20G0013_lores.jpg \| RHD - showing valvular thickening and thickening of the cordae tendinae. (WC)~~
	~~Image:Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores.jpg \| RHD - showing valvular thickening - aortic valve. (WC)~~
	~~</gallery>~~
	~~===Microscopic===~~
	~~Features:<ref name=Ref_PBoD593>{{Ref PBoD\|593}}</ref>~~
	*Caterpillar cells ([[AKA]] Anitschkow cells)
	**Abundant eosinophilic cytoplasm.
	**Moderately-poorly defined cell border.
	**Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination.
	**Pathognomonic for rheumatic fever.

	*Aschoff bodies - usually in the heart itself:
	**Jumbled collagen, eosinophilic.
	**Surrounded by lymphocytes (T cells) +/- plasma cells.

	~~Notes:~~
	*Anitschkow cells are thought to be histocytes and Aschoff bodies are thought to be [[granuloma]]s.<ref name=pmid3070554>{{Cite journal \| last1 = Love \| first1 = GL. \| last2 = Restrepo \| first2 = C. \| title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. \| journal = Mod Pathol \| volume = 1 \| issue = 4 \| pages = 256-61 \| month = Jul \| year = 1988 \| doi = \| PMID = 3070554 }}</ref>
	**This is disputed.<ref name=pmid10399163>{{Cite journal \| last1 = Stehbens \| first1 = WE. \| last2 = Zuccollo \| first2 = JM. \| title = Anitschkow myocytes or cardiac histiocytes in human hearts. \| journal = Pathology \| volume = 31 \| issue = 2 \| pages = 98-101 \| month = May \| year = 1999 \| doi = \| PMID = 10399163 }}</ref>

	~~====Images====~~
	~~<gallery>~~
	~~Image:Rheumatic_heart_disease_-_intermed_mag.jpg \| RHD - intermed. mag. (WC/Nephron)~~
	~~Image:Rheumatic_heart_disease_-_3_-_high_mag.jpg \| RHD - high mag. (WC/Nephron)~~
	~~Image:Rheumatic_heart_disease_-_3b_-_very_high_mag.jpg \| RHD - very high mag. (WC/Nephron)~~
	~~Image:Aschoff_Body_in_Rheumatic_Myocarditis.jpg \| Aschoff body (WC/Uthman)~~
	~~Image:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg \| Anitschkow myocytes (WC/Uthman)~~
	~~</gallery>~~
	~~===IHC===~~
	Features (Aschoff bodies & Anitschkow cells):<ref name=pmid3070554>{{Cite journal \| last1 = Love \| first1 = GL. \| last2 = Restrepo \| first2 = C. \| title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. \| journal = Mod Pathol \| volume = 1 \| issue = 4 \| pages = 256-61 \| month = Jul \| year = 1988 \| doi = \| PMID = 3070554 }}~~</ref>~~
	*S100 -ve.
	*Muscle specific actin -ve.
	*Desmin -ve.
	*NF -ve.
	*Vimentin +ve.
	*CD45 +ve (weak).

	==Infective endocarditis==		==Infective endocarditis==

Michael: /* Myxomatous degeneration */ split out

2015-04-05T05:51:26Z

Myxomatous degeneration: split out

← Older revision		Revision as of 05:51, 5 April 2015
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	==Myxomatous degeneration==		==Myxomatous degeneration==
	~~===General===~~		{{Main\|Myxomatous degeneration}}
	*Usually affects the mitral valve.
	*Female > male,<ref>URL: [http://emedicine.medscape.com/article/759004-overview http://emedicine.medscape.com/article/759004-overview]. Accessed on: 8 June 2010.</ref> disputed by Toronto data.<ref name=leong>{{~~cite journal~~ \|author=Leong SW, Soor GS, Butany J, Henry J, Thangaroopan M, Leask RL \|title=Morphological findings in 192 surgically excised native mitral valves \|journal=Can J Cardiol \|volume=22 \|issue=12 \|pages=1055-61 \|year=2006 \|month=October \|pmid=17036100 \|doi= \|url=}}</ref>
	*Associated with [[Marfan's syndrome]] and [[Turner syndrome]] (Monosomy X).<ref>{{cite journal \|author=Wigle ED, Rakowski H, Ranganathan N, Silver MC \|title=Mitral valve prolapse \|journal=Annu. Rev. Med. \|volume=27 \|issue= \|pages=165–80 \|year=1976 \|pmid=779595 \|doi=10.1146/annurev.me.27.020176.001121 \|url=}}</ref>

	~~===Gross===~~
	~~Features:<ref name=Ref_PBoD591>{{Ref PBoD\|591~~}}~~</ref>~~
	*No commissural fusion.
	**Commissural fusion typical of rheumatic heart disease.
	*Thickened.
	*Rubbery consistency.
	*Reactive/secondary changes.
	**Fibrosis due to prolapse/abnormal contact of valve with other structures.
	**Clots/organized thrombus - due to stasis.

	~~===Microscopic===~~
	*Thinning of ''fibrosa layer''.
	*Thickening of ''spongiosa layer'' with mucoid (myxomatous) material. (key feature).
	*+/-Secondary changes (due to valvular dysfunction): thrombi, fibrosis.

	~~====Staining====~~
	*Movat stain.
	**Acid fuchsin, alcian blue, crocein scarlet, elastic hematoxylin, pathology consultation, and saffron.<ref>URL: [http://www.mayomedicallaboratories.com/test-catalog/Overview/9832 http://www.mayomedicallaboratories.com/test-catalog/Overview/9832]. Accessed on: 8 June 2010.</ref><ref name=penn_med>Modified Movat's Pentachrome Stain. University Penn Medicine. URL: [http://www.med.upenn.edu/mcrc/histology_core/movat.shtml http://www.med.upenn.edu/mcrc/histology_core/movat.shtml]. Accessed on: January 29, 2009.</ref>

	~~Interpretation of Movat stain:<ref name=penn_med/>~~
	*Black = nuclei and elastic fibers.
	*Yellow = collagen and reticular fibers.
	*Blue = mucin, ground substance.
	*Red (intense) = fibrin.
	*Red = muscle.

	~~Image:~~
	~~<gallery>~~
	~~Image:Myxomatous_aortic_valve.jpg \| Myxomatous valve. [[Movat stain]]. (WC/Nephron)~~
	~~</gallery>~~

	=Infective conditions=		=Infective conditions=

Michael at 20:52, 19 March 2015

2015-03-19T20:52:35Z

← Older revision		Revision as of 20:52, 19 March 2015
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			[[Image:Gray497.png\|thumb\|right\|Aortic valve - drawing. (WC/Gray's Anatomy)]]
	'''[[Heart]] valves''' are the domain of the cardiac surgeon and their bread & butter.		'''[[Heart]] valves''' are the domain of the cardiac surgeon and their bread & butter.

Michael: /* Mitral valve prolapse */

2014-09-12T05:03:57Z

Mitral valve prolapse

← Older revision		Revision as of 05:03, 12 September 2014
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	===Microscopic===		===Microscopic===
	Features:<ref name=pmid3049284/><ref name=Ref_PCPBoD8_296>{{Ref PCPBoD8\|296}}</ref>		Features:<ref name=pmid3049284/><ref name=Ref_PCPBoD8_296>{{Ref PCPBoD8\|296}}</ref>
	*Increased thickness of spongiosa layer.		*Increased thickness of spongiosa layer. ‡
	*Thinning of the fibrosa layer.		*Thinning of the fibrosa layer.
	*+/-Fibrin deposition - atrial aspect.		*+/-Fibrin deposition - atrial aspect.

			Notes:
			*‡ The Tthicking may be due to superimposed fibrosis, instead of spongiosa layer thickening.<ref name=pmid24316086>{{Cite journal \| last1 = Roberts \| first1 = WC. \| last2 = Vowels \| first2 = TJ. \| last3 = Ko \| first3 = JM. \| last4 = Hebeler \| first4 = RF. \| title = Gross and histological features of excised portions of posterior mitral leaflet in patients having operative repair of mitral valve prolapse and comments on the concept of missing (= ruptured) chordae tendineae. \| journal = J Am Coll Cardiol \| volume = 63 \| issue = 16 \| pages = 1667-74 \| month = Apr \| year = 2014 \| doi = 10.1016/j.jacc.2013.11.017 \| PMID = 24316086 }}</ref>

	DDx:		DDx:

Michael: /* Mitral valve */

2014-09-12T04:53:59Z

Mitral valve

← Older revision		Revision as of 04:53, 12 September 2014
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	**No fusion.		**No fusion.

			Note:
			*The [[cut-up]] is described in ''[[grossing mitral valves]]''.
	===Microscopic===		===Microscopic===
	Similar to the aortic valve - layers:		Similar to the aortic valve - layers:

Michael: /* Aortic valve */

2014-09-12T04:52:46Z

Aortic valve

← Older revision		Revision as of 04:52, 12 September 2014
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	*Posterior (non-coronary cusp).		*Posterior (non-coronary cusp).

			Note:
			*The [[cut-up]] is described in ''[[grossing aortic valves]]''.
	===Microscopic===		===Microscopic===
	Three layers (from proximal (ventricular side) to distal (valsalva side)):<ref name=Ref_PBoD558>{{Ref PBoD\|558}}</ref>		Three layers (from proximal (ventricular side) to distal (valsalva side)):<ref name=Ref_PBoD558>{{Ref PBoD\|558}}</ref>

Michael: /* Infective endocarditis */ split out

2014-07-03T16:10:26Z

Infective endocarditis: split out

← Older revision		Revision as of 16:10, 3 July 2014
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	==Infective endocarditis==		==Infective endocarditis==
	~~:''Bacterial endocarditis'' and ''subacute bacterial endocarditis'' redirect here.~~		{{Main\|Infective endocarditis}}
	*Abbreviated ''IE''.
	~~===General===~~
	*Infection of the endocardium - often involves the valves (which are covered by endocardium).
	*Before the time of antibiotics -- 100% fatal.

	~~====Organisms====~~
	~~Most common organism overall:~~
	*''Staphylococcus aureus''.<ref name=pmid12092480>{{Cite journal \| last1 = Petti \| first1 = CA. \| last2 = Fowler \| first2 = VG. \| title = Staphylococcus aureus bacteremia and endocarditis. \| journal = Infect Dis Clin North Am \| volume = 16 \| issue = 2 \| pages = 413-35, x-xi \| month = Jun \| year = 2002 \| doi = \| PMID = 12092480 }}</ref>

	~~Organisms associated with particular clinical scenarios:~~
	*IV drug users / normal valves = ''Staphylococcus aureus''.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>
	*Previously damaged valve = ''Streptococcus viridans''.
	*Prosthetic valves = ''Staphylococcus epidermidis''.<ref name=pmid19660339>{{Cite journal \| last1 = Alonso-Valle \| first1 = H. \| last2 = Fariñas-Alvarez \| first2 = C. \| last3 = García-Palomo \| first3 = JD. \| last4 = Bernal \| first4 = JM. \| last5 = Martín-Durán \| first5 = R. \| last6 = Gutiérrez Díez \| first6 = JF. \| last7 = Revuelta \| first7 = JM. \| last8 = Fariñas \| first8 = MC. \| title = Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period. \| journal = J Thorac Cardiovasc Surg \| volume = 139 \| issue = 4 \| pages = 887-93 \| month = Apr \| year = 2010 \| doi = 10.1016/j.jtcvs.2009.05.042 \| PMID = 19660339 }}</ref>

	~~Organisms that less commonly cause ''IE'' are known as the ''HACEK group'':<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>~~
	*'''''H'''aemophilus'' (''Haemophilus parainfluenzae'', ''Haemophilus aphrophilus'', ''Haemophilus paraphrophilus'').
	*'''''A'''ctinobacillus'' (''Actinobacillus actinomycetemcomitans'', ''Aggregatibacter aphrophilus'').
	*'''''C'''ardiobacterium hominis.
	*'''''E'''ikenella corrodens''. †
	*'''''K'''ingella'' (''Kingella kingae'').

	~~Notes:~~
	* † ''Enterococci'' are not included in this list but are lumped with the ''HACEK organisms''.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>

	~~Others:~~
	*''Stenotrophomonas maltophilia'' (previously ''Pseudomonas maltophilia'') - Gram-negative bacillus,<ref>{{Cite journal \| last1 = Gautam \| first1 = V. \| last2 = Ray \| first2 = P. \| last3 = Vandamme \| first3 = P. \| last4 = Chatterjee \| first4 = SS. \| last5 = Das \| first5 = A. \| last6 = Sharma \| first6 = K. \| last7 = Rana \| first7 = S. \| last8 = Garg \| first8 = RK. \| last9 = Madhup \| first9 = SK. \| title = Identification of lysine positive non-fermenting gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex). \| journal = Indian J Med Microbiol \| volume = 27 \| issue = 2 \| pages = 128-33 \| month = \| year = \| doi = 10.4103/0255-0857.49425 \| PMID = 19384035 }}</ref> rarely causes endocarditis,<ref name=pmid23021356>{{Cite journal \| last1 = Carrillo-Córdova \| first1 = JR. \| last2 = Amezcua-Guerra \| first2 = LM. \| title = Autoimmunity as a possible predisposing factor for Stenotrophomonas maltophilia endocarditis. \| journal = Arch Cardiol Mex \| volume = 82 \| issue = 3 \| pages = 204-7 \| month = \| year = \| doi = 10.1016/j.acmx.2012.03.001 \| PMID = 23021356 }}</ref> high mortality.<ref>{{Cite journal \| last1 = Fontenier \| first1 = G. \| last2 = Freschard \| first2 = R. \| last3 = Mourot \| first3 = M. \| title = Study of the corrosion in vitro and in vivo of magnesium amodes involved in an implantable bioelectric battery. \| journal = Med Biol Eng \| volume = 13 \| issue = 5 \| pages = 683-9 \| month = Sep \| year = 1975 \| doi = \| PMID = 1186330 }}</ref>

	~~====Clinical====~~
	*Diagnosed (clinically) using the ''Duke criteria''.<ref>[http://www.medcalc.com/endocarditis.html http://www.medcalc.com/endocarditis.html]</ref><ref>{{cite journal \|author=Durack DT, Lukes AS, Bright DK \|title=New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service \|journal=Am. J. Med. \|volume=96 \|issue=3 \|pages=200-9 \|year=1994 \|month=March \|pmid=8154507 \|doi= \|url=}}</ref>
	**Positive blood cultures.
	**Cardiac involvement - vegetation.
	**+/-Febrile.

	~~Subdivided into:~~
	~~#Acute IE.~~
	~~#*Classically due to ''Staphylococcus aureus''.~~
	~~#Subacute IE.~~
	~~#*Classically due to ''Streptococcus viridans''.~~

	~~Treatment:<ref name=pmid23968767>~~{{Cite journal \| last1 = Gaca \| first1 = JG. \| last2 = Sheng \| first2 = S. \| last3 = Daneshmand \| first3 = M. \| last4 = Rankin \| first4 = JS. \| last5 = Williams \| first5 = ML. \| last6 = O'Brien \| first6 = SM. \| ~~last7 = Gammie \| first7 = JS. \| title = Current Outcomes for Tricuspid Valve~~ Infective ~~Endocarditis Surgery in North America. \| journal = Ann Thorac Surg \| volume = \| issue = \| pages = \| month = Aug \| year = 2013 \| doi = 10.1016/j.athoracsur.2013.05.046 \| PMID = 23968767 }}</ref>~~
	*Usually medical management.<ref name=pmid16506645>{{Cite journal \| last1 = Chait \| first1 = RD. \| last2 = Midwall \| first2 = J. \| title = Tricuspid valvectomy: long-term survival and surgical options. \| journal = Clin Cardiol \| volume = 29 \| issue = 2 \| pages = 83-4 \| month = Feb \| year = 2006 \| doi = \| PMID = 16506645 \| URL = http://onlinelibrary.wiley.com/doi/10.1002/clc.4960290210/pdf }}</ref>
	*Valve replacement.
	*Valve repair.
	*Valvectomy - for tricuspid valve.

	~~===Gross===~~
	*Location - left-sided involvement (mitral, aortic) more common than right-sided involvement (pulmonic, tricuspid).
	**This is reversed in IV drug users.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref><ref name=pmid16401952>{{Cite journal \| last1 = Mathura \| first1 = KC. \| last2 = Thapa \| first2 = N. \| last3 = Rauniyar \| first3 = A. \| last4 = Magar \| first4 = A. \| last5 = Gurubacharya \| first5 = DL. \| last6 = Karki \| first6 = DB. \| title = Injection drug use and tricuspid valve endocarditis~~. \| journal = Kathmandu Univ Med J (KUMJ) \| volume = 3 \| issue = 1 \| pages = 84-6 \| month = \| year = \| doi = \| PMID = 16401952~~ }}~~</ref>~~
	*+/-Valvular destruction.
	**More common in acute IE.
	*+/-Distant emboli, e.g. [[splenic infarct]].
	**More common in acute IE.
	*+/-Valvular vegetations.
	**Irregular ball of loosely adherent tissue - dull, irregular surface.
	**On the ventricular aspect in aortic valve IE.
	**Larger in acute IE.

	~~Image:~~
	*[http://www.flickr.com/photos/11462589@N05/1126726482/ Infective endocarditis - aortic valve (flickr.com)].

	~~===Microscopic===~~
	*Inflammatory infiltrate (key feature @ low power):
	**+/-Plasma cells - subacute.
	**+/-Neutrophils - typically abundant, may be rare in subacute.<ref>URL: [http://emedicine.medscape.com/article/216650-overview#a0104 http://emedicine.medscape.com/article/216650-overview#a0104]. Accessed on: 26 November 2013.</ref>
	*Microorganisms - '''key feature''' (diagnostic).
	**Hard to see (even at high power).

	~~===Stains===~~
	*[[GMS stain]] (Gomori Methenamine-silver stain).
	**Look for [[fungi]].
	*[[Gram stain]].
	**Look for bacteria.

	~~===Sign out===~~
	~~<pre>~~
	~~TRICUSPID VALVE, VALVECTOMY:~~
	~~- FRAGMENTS OF VALVE WITH INFECTIVE ENDOCARDITIS -- ABUNDANT COCCI~~
	~~ORGANISMS IDENTIFIED.~~
	~~- THIN RIM OF CARDIAC MUSCLE WITHOUT APPARENT PATHOLOGY.~~
	~~</pre>~~

	~~<pre>~~
	~~MITRAL VALVE, VALVE REPLACEMENT:~~
	~~- FRAGMENTS OF VALVE WITH INFECTIVE ENDOCARDITIS -- ABUNDANT COCCI~~
	~~ORGANISMS IDENTIFIED.~~
	~~</pre>~~

	~~====No microorganisms====~~
	~~<pre>~~
	~~AORTIC VALVE (BICUSPID), VALVE REPLACEMENT:~~
	~~- BICUSPID VALVE WITH CALCIFIC AORTIC STENOSIS AND MILD ENDOCARDITIS.~~
	~~- NO MICROORGANISMS APPARENT.~~
	~~</pre>~~

	~~====Micro====~~
	~~The sections show valve tissue with an attached vegetation with abundant cocci organisms~~
	~~and neutrophils. No calcification is apparent.~~

	~~=====No microorganisms=====~~
	~~The sections show valve tissue with marked calcification, scattered neutrophils and plasma cells. No microorganisms are identified with routine stains.~~

	=Non-infective conditions=		=Non-infective conditions=

Michael: /* Calcific aortic stenosis */

2014-04-16T17:45:28Z

Calcific aortic stenosis

← Older revision		Revision as of 17:45, 16 April 2014
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	==Calcific aortic stenosis==		==Calcific aortic stenosis==
	*Abbreviated ''CAS''.		*Abbreviated ''CAS''.
	~~===General===~~		{{Main\|Calcific aortic stenosis}}
	*Somewhat similar to [[atherosclerosis]]; however, considered a separate entity.<ref>{{~~cite journal~~ \|author=Otto CM \|title=Calcific aortic stenosis--time to look more closely at the valve \|journal=N. Engl. J. Med. \|volume=359 \|issue=13 \|pages=1395-8 \|year=2008 \|month=September \|pmid=18815402 \|doi=10.1056/NEJMe0807001 \|url=}}</ref>
	*Mitral valve is usually normal.
	*Most common cause of aortic stenosis.

	~~DDx of aortic stenosis:~~
	#Calcific aortic stenosis.
	~~#[[Bicuspid aortic valve]] with calcific aortic stenosis.~~
	~~#[[Rheumatic heart disease]].~~

	~~Clinical (mnemonic ''SAD''):~~
	*Syncope.
	*Angina.
	*Dyspnea (shortness of breath) - first symptom.

	~~===Microscopic===~~
	~~Features:<ref name=Ref_PBoD590>{{Ref PBoD\|590~~}}~~</ref>~~
	*[[Dystrophic calcification]]<ref name=pmid12779138>{{Cite journal \| last1 = Novaro \| first1 = GM. \| last2 = Griffin \| first2 = BP. \| title = Calcific aortic stenosis: another face of atherosclerosis? \| journal = Cleve Clin J Med \| volume = 70 \| issue = 5 \| pages = 471-7 \| month = May \| year = 2003 \| doi = \| PMID = 12779138 \| URL = http://www.ccjm.org/cgi/pmidlookup?view=long&pmid=12779138 }}</ref> - affects the valsalva side of the valve.
	**It affects the fibrosa.
	*Primarily at the base of the valve, i.e. there is relative sparing the free edge.

	~~Note:~~
	*There should be no [[neutrophil]]s and no microorganisms.
	*An expanded spongiosa layer may be seen in the context of calcification.{{fact}}

	~~DDx:~~
	*[[Infective endocarditis]] - inflammatory cells (esp. neutrophils), microorganisms (e.g. cocci).
	*[[Bicuspid aortic valve]].
	*[[Rheumatic heart disease]].

	~~===Sign out===~~
	~~<pre>~~
	~~AORTIC VALVE, VALVE REPLACEMENT:~~
	~~- CALCIFIC AORTIC STENOSIS.~~
	~~</pre>~~

	~~====Micro====~~
	~~The sections show valve tissue with marked calcification of the fibrosa layer. No neutrophils are identified. No microorganisms are identified with routine stains.~~

	==Localized dystrophic heart valve amyloidosis==		==Localized dystrophic heart valve amyloidosis==

Michael: /* Sign out */

2014-01-15T15:26:18Z

Sign out

← Older revision		Revision as of 15:26, 15 January 2014
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	===Sign out===		===Sign out===
	~~<pre>~~
	~~AORTIC VALVE, VALVE REPLACEMENT:~~
	~~- BICUSPID VALVE WITH CALCIFIC AORTIC STENOSIS.~~
	~~</pre>~~

	~~====Cannot determine at gross====~~
	<pre>		<pre>
	AORTIC VALVE, REPLACEMENT:		AORTIC VALVE, REPLACEMENT:
	- AORTIC VALVE WITH CALCIFIC STENOSIS~~, REPORTED BICUSPID AT SURGERY~~.		- BICUSPID AORTIC VALVE WITH CALCIFIC STENOSIS.
	</pre>		</pre>

Michael: /* Biscupid aortic valve */

2014-01-15T15:24:29Z

Biscupid aortic valve

← Older revision		Revision as of 15:24, 15 January 2014
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	*Associated with ascending [[aortic aneurysm]]s - x10 risk of [[aortic dissection]] vs. normal population.<ref name=pmid18514024/>		*Associated with ascending [[aortic aneurysm]]s - x10 risk of [[aortic dissection]] vs. normal population.<ref name=pmid18514024/>
	*30% develop serious morbidity.<ref name=pmid18514024/>		*30% develop serious morbidity.<ref name=pmid18514024/>
	*Associated with early development of [[calcific aortic stenosis]].		*Associated with early development of [[calcific aortic stenosis]] - often in 50s.
			**Calcific disease in normal (tricuspid) aortic valves is typically seen in the 70s.
	*[[Coarctation of the aorta]].<ref name=pmid16129122>{{Cite journal \| last1 = Braverman \| first1 = AC. \| last2 = Güven \| first2 = H. \| last3 = Beardslee \| first3 = MA. \| last4 = Makan \| first4 = M. \| last5 = Kates \| first5 = AM. \| last6 = Moon \| first6 = MR. \| title = The bicuspid aortic valve. \| journal = Curr Probl Cardiol \| volume = 30 \| issue = 9 \| pages = 470-522 \| month = Sep \| year = 2005 \| doi = 10.1016/j.cpcardiol.2005.06.002 \| PMID = 16129122 }}</ref>		*[[Coarctation of the aorta]].<ref name=pmid16129122>{{Cite journal \| last1 = Braverman \| first1 = AC. \| last2 = Güven \| first2 = H. \| last3 = Beardslee \| first3 = MA. \| last4 = Makan \| first4 = M. \| last5 = Kates \| first5 = AM. \| last6 = Moon \| first6 = MR. \| title = The bicuspid aortic valve. \| journal = Curr Probl Cardiol \| volume = 30 \| issue = 9 \| pages = 470-522 \| month = Sep \| year = 2005 \| doi = 10.1016/j.cpcardiol.2005.06.002 \| PMID = 16129122 }}</ref>