William C Roberts1, Travis J Vowels2, Jong M Ko2, Robert F Hebeler3. 1. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas. Electronic address: wc.roberts@baylorhealth.edu. 2. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas. 3. Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas.
Abstract
OBJECTIVES: The aim of the study is to describe gross and histological features of operatively excised portions of mitral valves in patients with mitral valve prolapse (MVP). BACKGROUND: Although numerous articles on MVP (myxomatous or myxoid degeneration, billowing or floppy mitral valve) have appeared, 2 virtually constant histological features have been underemphasized or overlooked: 1) the presence of superimposed fibrous tissue on both surfaces of the leaflets and surrounding many chordae tendineae; and 2) the absence of many chordae tendineae on the ventricular surfaces of the leaflets as the result of their being hidden (i.e., covered up) by the superimposed fibrous tissue. METHODS: We examined operatively excised portions of prolapsed posterior mitral leaflets in 37 patients having operative repair. RESULTS: Histological study of elastic-tissue stained sections disclosed that the leaflet thickening was primarily due to the superimposed fibrous tissue. All leaflets had variable increases in the spongiosa element within the leaflet itself with some disruption and/or loss of the fibrosa element and occasionally complete separation of it from the spongiosa element. Both the leaflet and chordae were separated from the superimposed fibrous tissue by their black-staining elastic membranes. CONCLUSIONS: These findings demonstrate that the posterior leaflet thickening in MVP is mainly due to the superimposed fibrous tissue rather than to an increased volume of the spongiosa element of the leaflet itself. The superimposed fibrous tissue on both leaflet and chordae is likely the result of subsequent abnormal contact of the leaflets and chordae with one another. Chordal rupture (i.e., missing chordae) occurred in all 37 patients, but finding individual ruptured chords was rare.
OBJECTIVES: The aim of the study is to describe gross and histological features of operatively excised portions of mitral valves in patients with mitral valve prolapse (MVP). BACKGROUND: Although numerous articles on MVP (myxomatous or myxoid degeneration, billowing or floppy mitral valve) have appeared, 2 virtually constant histological features have been underemphasized or overlooked: 1) the presence of superimposed fibrous tissue on both surfaces of the leaflets and surrounding many chordae tendineae; and 2) the absence of many chordae tendineae on the ventricular surfaces of the leaflets as the result of their being hidden (i.e., covered up) by the superimposed fibrous tissue. METHODS: We examined operatively excised portions of prolapsed posterior mitral leaflets in 37 patients having operative repair. RESULTS: Histological study of elastic-tissue stained sections disclosed that the leaflet thickening was primarily due to the superimposed fibrous tissue. All leaflets had variable increases in the spongiosa element within the leaflet itself with some disruption and/or loss of the fibrosa element and occasionally complete separation of it from the spongiosa element. Both the leaflet and chordae were separated from the superimposed fibrous tissue by their black-staining elastic membranes. CONCLUSIONS: These findings demonstrate that the posterior leaflet thickening in MVP is mainly due to the superimposed fibrous tissue rather than to an increased volume of the spongiosa element of the leaflet itself. The superimposed fibrous tissue on both leaflet and chordae is likely the result of subsequent abnormal contact of the leaflets and chordae with one another. Chordal rupture (i.e., missing chordae) occurred in all 37 patients, but finding individual ruptured chords was rare.
Authors: Mark A Oyama; Chad Elliott; Kerry A Loughran; Alexander P Kossar; Estibaliz Castillero; Robert J Levy; Giovanni Ferrari Journal: Cardiovasc Pathol Date: 2020-01-07 Impact factor: 2.185
Authors: Mihaela Octavia Popa; Ana Maria Irimia; Mihai Nicolae Papagheorghe; Elena Miruna Vasile; Simona Andreea Tircol; Raluca Andreea Negulescu; Catalina Toader; Robert Adam; Lucian Dorobantu; Cristina Caldararu; Maria Alexandrescu; Sebastian Onciul Journal: Discoveries (Craiova) Date: 2016-06-30