Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.
Arq Bras Cardiol. 2021 Mar;116(3):404-412. doi: 10.36660/abc.20200154.
The underlying mechanisms by which rheumatic heart disease (RHD) lead to severe valve dysfunction are not completely understood.
The present study evaluated the histopathological changes in mitral valves (MV) seeking an association between the pattern of predominant valvular dysfunction and histopathological findings.
In 40 patients who underwent MV replacement due to RHD, and in 20 controls that underwent heart transplant, histological aspects of the excised MV were analyzed. Clinical and echocardiographic data were also collected. Histological analyses were performed using hematoxylin-eosin staining. Inflammation, fibrosis, neoangiogenesis, calcification and adipose metaplasia were determined. A p value<0.05 was considered to be statistically significant.
The mean age of RHD patients was 53±13 years, 36 (90%) were female, whereas the mean age of controls was 50±12 years, similar to the cases, with the majority of males (70%). The rheumatic valve endocardium presented greater thickness than the controls (1.3±0.5 mm versus 0.90±0.4 mm, p=0.003, respectively), and a more intense inflammatory infiltrate in the endocardium (78% versus 36%; p=0.004), with predominance of mononuclear cells. Moderate to marked fibrosis occurred more frequently in rheumatic valves than in control valves (100% vs. 29%; p<0.001). Calcification occurred in 35% of rheumatic valves, especially among stenotic valves, which was associated with the mitral valve area (p=0.003).
Despite intense degree of fibrosis, the inflammatory process remains active in the rheumatic mitral valve, even at late disease with valve dysfunction. Calcification predominated in stenotic valves and in patients with right ventricular dysfunction.
风湿性心脏病（RHD）导致严重瓣膜功能障碍的潜在机制尚不完全清楚。
本研究评估了二尖瓣（MV）的组织病理学变化，旨在寻找主要瓣膜功能障碍模式与组织病理学发现之间的关联。
在 40 例因 RHD 行 MV 置换术的患者和 20 例因心脏移植而行 MV 置换术的患者中，分析了切除的 MV 的组织学特征。还收集了临床和超声心动图数据。使用苏木精-伊红染色进行组织学分析。确定炎症、纤维化、新生血管形成、钙化和脂肪化生。p 值<0.05 被认为具有统计学意义。
RHD 患者的平均年龄为 53±13 岁，36 例（90%）为女性，而对照组的平均年龄为 50±12 岁，与病例相似，大多数为男性（70%）。风湿性瓣膜心内膜比对照组更厚（1.3±0.5mm 与 0.90±0.4mm，p=0.003），心内膜炎症浸润更强烈（78%与 36%；p=0.004），以单核细胞为主。风湿性瓣膜比对照组更常发生中度至重度纤维化（100%比 29%；p<0.001）。35%的风湿性瓣膜发生钙化，尤其是在狭窄的瓣膜中，这与二尖瓣瓣口面积有关（p=0.003）。
尽管纤维化程度严重，但风湿性二尖瓣的炎症过程仍然活跃，即使在疾病晚期出现瓣膜功能障碍。钙化在狭窄的瓣膜和右心室功能障碍的患者中更为常见。
