Difference between revisions of "Heart valves"

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Heart valves (view source)

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*Anitschkow's cells (caterpillar cells)?
*Anitschkow's cells (caterpillar cells)?
**Rheumatic heart disease.
**Rheumatic heart disease.
***Image: [http://commons.wikimedia.org/wiki/File:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg Anitschkow cells (WC)].


*Aschoff bodies?
*Aschoff bodies?
**Rheumatic heart disease.
**Rheumatic heart disease.
***Image: [http://commons.wikimedia.org/wiki/File:Aschoff_Body_in_Rheumatic_Myocarditis.jpg Aschoff body (WC)].


*Thickening of spongiosa (layer)?
*Thickening of spongiosa (layer)?
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===General===
===General===
*Usually affects the mitral valve.
*Usually affects the mitral valve.
*female > male,<ref>[http://emedicine.medscape.com/article/759004-overview]</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>
*Female > male,<ref>[http://emedicine.medscape.com/article/759004-overview]</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>
*Assoc. with [[Marfan's syndrome]] and [[Turner's syndrome]].<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>
*Associated with [[Marfan's syndrome]] and [[Turner's syndrome]].<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===
===Gross===
Features<ref>PBoD P.591</ref>
Features<ref>PBoD P.591.</ref>
*no commissural fusion  
*No commissural fusion.
**commissural fusion typical of rheumatic heart disease
**Commissural fusion typical of rheumatic heart disease.
*thickened
*Thickened.
*rubbery consistency
*Rubbery consistency.
*reactive/secondary changes
*Reactive/secondary changes.
**fibrosis due to prolapse/abnormal contact of valve with other structures
**Fibrosis due to prolapse/abnormal contact of valve with other structures.
**clots/organized thrombus - due to stasis
**Clots/organized thrombus - due to stasis.


===Microscopic===
===Microscopic===
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====Staining====
====Staining====
*Movat stain
*Movat stain.
**acid fuchsin, alcian blue, crocein scarlet, elastic hematoxylin, pathology consultation, and saffron.<ref>[http://www.mayomedicallaboratories.com/test-catalog/Overview/9832]</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>
**Acid fuchsin, alcian blue, crocein scarlet, elastic hematoxylin, pathology consultation, and saffron.<ref>[http://www.mayomedicallaboratories.com/test-catalog/Overview/9832]</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/>
Interpretation of Movat stain:<ref name=penn_med/>
*black = nuclei and elastic fibers
*black = nuclei and elastic fibers.
*yellow = collagen and reticular fibers
*yellow = collagen and reticular fibers.
*blue = mucin, ground substance
*blue = mucin, ground substance.
*red (intense) = fibrin
*red (intense) = fibrin.
*red = muscle
*red = muscle.


==Rheumatic heart disease==
==Rheumatic heart disease==
===General===
===General===
*Classically leads to mitral valve stenosis.
*Classically leads to mitral valve stenosis.
**Rheumatic fever accounts for 99% of mitral stenosis<ref>PBoD P.594</ref>
**Rheumatic fever accounts for 99% of mitral stenosis<ref>PBoD P.594.</ref>
*Disease less frequent today - as streptococcal pharynigits is treated.
*Disease less frequent today - as streptococcal pharynigits is treated.


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===Microscopic===
===Microscopic===
Features:<ref>PBoD P.593</ref>
Features:<ref>PBoD P.593.</ref>
*Caterpillar cell (aka Anitschkow cells)
*Caterpillar cell (aka Anitschkow cells)
**Abundant eosinophilic cytoplasm.
**Abundant eosinophilic cytoplasm.
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**Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some immagination.
**Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some immagination.
**Pathognomonic for rheumatic fever.
**Pathognomonic for rheumatic fever.
**Image: [http://en.wikipedia.org/wiki/File:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg Anitschkow myocytes] - wikipedia.org.
 
*Aschoff bodies:
*Aschoff bodies:
**Usually in the heart itself,
**Usually in the heart itself,
**Jumbled collagen, eosinophilic, and
**Jumbled collagen, eosinophilic, and
**Surrounded by lymphocytes (T cells) +/- plasma cells.
**Surrounded by lymphocytes (T cells) +/- plasma cells.
Images:
*[http://commons.wikimedia.org/wiki/File:Aschoff_Body_in_Rheumatic_Myocarditis.jpg Aschoff body (WC)].
*[http://en.wikipedia.org/wiki/File:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg Anitschkow myocytes (WC)].


==Endocarditis==
==Endocarditis==
Michael
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