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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. |
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| **No fusion. | | **No fusion. |
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| | Note: |
| | *The [[cut-up]] is described in ''[[grossing mitral valves]]''. |
| ===Microscopic=== | | ===Microscopic=== |
| Similar to the aortic valve - layers: | | Similar to the aortic valve - layers: |
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| ==Myxomatous degeneration== | | ==Myxomatous degeneration== |
| ===General===
| | {{Main|Myxomatous degeneration}} |
| *Usually affects the mitral valve.
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| *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>
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| *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>
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| ===Gross===
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| Features:<ref name=Ref_PBoD591>{{Ref PBoD|591}}</ref>
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| *No commissural fusion.
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| **Commissural fusion typical of rheumatic heart disease.
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| *Thickened.
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| *Rubbery consistency.
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| *Reactive/secondary changes.
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| **Fibrosis due to prolapse/abnormal contact of valve with other structures.
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| **Clots/organized thrombus - due to stasis.
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| ===Microscopic===
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| *Thinning of ''fibrosa layer''.
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| *Thickening of ''spongiosa layer'' with mucoid (myxomatous) material. (key feature).
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| *+/-Secondary changes (due to valvular dysfunction): thrombi, fibrosis.
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| ====Staining====
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| *Movat stain.
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| **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>
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| Interpretation of Movat stain:<ref name=penn_med/>
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| *Black = nuclei and elastic fibers.
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| *Yellow = collagen and reticular fibers.
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| *Blue = mucin, ground substance.
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| *Red (intense) = fibrin.
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| *Red = muscle.
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| Image:
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| <gallery>
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| Image:Myxomatous_aortic_valve.jpg | Myxomatous valve. [[Movat stain]]. (WC/Nephron)
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| </gallery>
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| =Infective conditions= | | =Infective conditions= |
| ==Rheumatic heart disease== | | ==Rheumatic heart disease== |
| :''Rheumatic fever'' redirects here.
| | {{Main|Rheumatic heart disease}} |
| *Abbreviated ''RHD''.
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| ===General===
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| *Classically leads to mitral valve stenosis.
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| **Rheumatic fever accounts for 99% of mitral stenosis.<ref name=Ref_PBoD594>{{Ref PBoD|594}}</ref>
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| ***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>
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| *Disease less frequent today - as streptococcal pharynigits is treated.
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| ===Gross===
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| *"Fish-mouth appearance".
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| **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.
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| **Image: [http://www.principia-eng.com/services/construction/IMG_3098.jpg Fish-mouth appearance - pipe (principia-eng.com)].
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| *Significant valvular thickening.
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| *Thickening and shortening of the cordae tendinae.
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| DDx:
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| *Thickening of the cordae tendinae due to micronodular [[cirrhosis]].<ref name=Ref_AoGP25>{{Ref AoGP|25}}</ref>
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| ====Images====
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| <gallery>
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| Image:Rheumatic_heart_disease,_gross_pathology_20G0013_lores.jpg | RHD - showing valvular thickening and thickening of the cordae tendinae. (WC)
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| Image:Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores.jpg | RHD - showing valvular thickening - aortic valve. (WC)
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| </gallery>
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD593>{{Ref PBoD|593}}</ref>
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| *Caterpillar cells ([[AKA]] Anitschkow cells)
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| **Abundant eosinophilic cytoplasm.
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| **Moderately-poorly defined cell border.
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| **Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination.
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| **Pathognomonic for rheumatic fever.
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| *Aschoff bodies - usually in the heart itself:
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| **Jumbled collagen, eosinophilic.
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| **Surrounded by lymphocytes (T cells) +/- plasma cells.
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| Notes:
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| *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>
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| **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>
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| ====Images====
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| <gallery>
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| Image:Rheumatic_heart_disease_-_intermed_mag.jpg | RHD - intermed. mag. (WC/Nephron)
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| Image:Rheumatic_heart_disease_-_3_-_high_mag.jpg | RHD - high mag. (WC/Nephron)
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| Image:Rheumatic_heart_disease_-_3b_-_very_high_mag.jpg | RHD - very high mag. (WC/Nephron)
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| Image:Aschoff_Body_in_Rheumatic_Myocarditis.jpg | Aschoff body (WC/Uthman)
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| Image:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg | Anitschkow myocytes (WC/Uthman)
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| </gallery>
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| ===IHC===
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| 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>
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| *S100 -ve.
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| *Muscle specific actin -ve.
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| *Desmin -ve.
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| *NF -ve.
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| *Vimentin +ve.
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| *CD45 +ve (weak).
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| ==Infective endocarditis== | | ==Infective endocarditis== |
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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. |
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| | 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> |
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| DDx: | | DDx: |