%0 Journal Article
%T Inflammatory Characteristics of Stenotic Aortic Valves: A Comparison between Rheumatic and Nonrheumatic Aortic Stenosis
%A Lars Wallby
%A Thora Steffensen
%A Lena Jonasson
%A Mats Broqvist
%J Cardiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/895215
%X Background. Although our comprehension of nonrheumatic aortic stenosis (NRAS) has increased substantially during the last decade, less is known about the histopathology of rheumatic aortic stenosis (RAS). The aim of this study was to investigate rheumatic aortic stenosis by means of analyses previously used in nonrheumatic stenosis. Material and Methods. Valve specimens were obtained from 39 patients referred to hospital due to significant aortic stenosis. According to established macroscopic criteria the valves were divided into two groups consisting of 29 NRAS and 10 RAS valves. Mononuclear inflammatory cells and apolipoproteins were investigated using immunohistochemical analyses. Results. The localisation of calcification differed in tricuspid nonrheumatic valves when compared to bicuspid nonrheumatic and rheumatic valves. The RAS valves revealed a lower degree of T lymphocyte infiltration compared with the NRAS valves. Infiltration of macrophages was seen in all valves and there were no differences regarding deposition of apolipoprotein. Conclusion. Rheumatic and nonrheumatic aortic stenotic valves show a similar and significant chronic inflammation. The similarities regarding the localisation of calcification indicate that the valve anomaly/morphology can influence the pathogenesis of aortic stenosis. Finally, our findings highlight the question of a postinflammatory valvular disease of other causes than rheumatic fever. 1. Introduction At the beginning of the 20th century, the incidence of rheumatic fever in the United States exceeded 100 per 100,000 population [1], and rheumatic heart disease was consequently the leading cause of heart valve illness. During the same century a gradual decrease in the incidence of rheumatic fewer was seen. The incidence ranged between 40 and 65 per 100,000 between 1935 and 1960 and is currently estimated at less than 2 per 100,000. Improved socioeconomic conditions in the western world during the late half of the 20th century, with an increased life span, dramatically changed the aetiologic panorama of aortic stenosis. The so-called degenerative, nonrheumatic aortic stenosis (NRAS) has become the foremost cause of significant aortic valve obstruction. In adults undergoing aortic valve replacement for symptomatic aortic stenosis in the USA, nonrheumatic tricuspid aortic stenosis (NRAS-T) accounts for 51% of cases, bicuspid aortic stenosis (NRAS-B) for 36%, and rheumatic aortic stenosis (RAS) for 9% [2]. However, the presence of an aortic stenosis of rheumatic origin has been under debate. The sole pathognomonic
%U http://www.hindawi.com/journals/crp/2013/895215/