Pathological Investigation of Congenital Bicuspid Aortic Valve Stenosis, Compared with Atherosclerotic Tricuspid Aortic Valve Stenosis and Congenital Bicuspid Aortic Valve Regurgitation

• Published in: PloS one Vol. 11; no. 8; p. e0160208
• Main Authors: Hamatani, Yasuhiro, Ishibashi-Ueda, Hatsue, Nagai, Toshiyuki, Sugano, Yasuo, Kanzaki, Hideaki, Yasuda, Satoshi, Fujita, Tomoyuki, Kobayashi, Junjiro, Anzai, Toshihisa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.08.2016; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Aged; Analysis; Aorta; Aortic stenosis; Aortic valve; Aortic Valve - abnormalities; Aortic Valve - pathology; Aortic Valve Insufficiency - congenital; Aortic Valve Insufficiency - pathology; Aortic valve stenosis; Aortic Valve Stenosis - pathology; Arteriosclerosis; Atherosclerosis; Bicuspid Aortic Valve Disease; Biology and Life Sciences; Calcification; Calcium; Calcium - metabolism; Cardiovascular disease; Cholesterol; Cholesterol - metabolism; Comparative analysis; Congenital diseases; Cytokines; Echocardiography; Extracellular matrix; Female; Fibrosis; Heart surgery; Heart Valve Diseases - pathology; Humans; Hypertension; Immunoglobulins; Inflammation; Investigations; Lesions; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Neovascularization; Neovascularization, Pathologic; Nitric oxide; Pathogenesis; Pathological histology; Pathology; Patients; Quality; Regurgitation; Rheumatic heart disease; Risk factors; Rodents; Severity of Illness Index; Stenosis; Valve leaflets; Vascularization; Ventricle; Young adults
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160208

Congenital bicuspid aortic valve (CBAV) is the main cause of aortic stenosis (AS) in young adults. However, the histopathological features of AS in patients with CBAV have not been fully investigated. We examined specimens of aortic valve leaflets obtained from patients who had undergone aortic valve re/placement at our institution for severe AS with CBAV (n = 24, CBAV-AS group), severe AS with tricuspid aortic valve (n = 24, TAV-AS group), and severe aortic regurgitation (AR) with CBAV (n = 24, CBAV-AR group). We compared the histopathological features among the three groups. Pathological features were classified using semi-quantitative methods (graded on a scale 0 to 3) by experienced pathologists without knowledge of the patients' backgrounds. The severity of inflammation, neovascularization, and calcium and cholesterol deposition did not differ between the CBAV-AS and TAV-AS groups, and these four parameters were less marked in the CBAV-AR group than in the CBAV-AS (all p<0.01). Meanwhile, the grade of valvular fibrosis was greater in the CBAV-AS group, compared with the TAV-AS and CBAV-AR groups (both p<0.01). In AS patients, thickness of fibrotic lesions was greater on the aortic side than on the ventricular side (both p<0.01). Meanwhile, thickness of fibrotic lesions was comparable between the aortic and ventricular sides in CBAV-AR patients (p = 0.35). Valvular fibrosis, especially on the aortic side, was greater in patients with CBAV-AS than in those without, suggesting a difference in the pathogenesis of AS between CBAV and TAV.