Active valvulitis associated with chronic rheumatic valvular disease and active myocarditis.

Abstract

From ten patients aged 15 to 40 years with chronic rheumatic valvular disease and histologically proved Aschoff bodies of active rheumatic myocarditis, the valves were evaluated for incidence, distribution and degree of severity of active inflammation. Prior to death, there had been clinical evidence of active rheumatic fever. In each case, active rheumatic valvulitis was present in at least one valve. Of the individual valves studied, 83% were involved by active inflammation of the leaflets or the anulus or both. The aortic valves was involved in 100% of cases, the mitral valve in 86%, the tricuspid valve in 78% and the pulmonary valve in 70%. The mitral and aortic valves were most frequently involved, but the mitral and tricuspid valves were most severely involved when affected. In every case, active rheumatic lesions of the left atrial appendage were present, but these tended to be less widely distributed than the myocardial Aschoff bodies. The high incidence of active valvulitis supports the concept that chronic fibrosing rheumatic valvular disease results from recurrent active inflammation. Such inflammation may occur without clinical suspicion of active rheumatic fever.

Calcified Rheumatic Valve Neoangiogenesis Is Associated With Vascular Endothelial Growth Factor Expression and Osteoblast-Like Bone Formation

“…1 Since 1924, a number of studies have demonstrated the histopathology of this disease with correlations of the degree of rheumatic activity, which include the presence of Aschoff bodies, nonspecific edema, and leukocyte infiltration. 2,3 Despite the high prevalence, increased morbidity, and well-described histopathological findings of this disease, little is known about the cellular mechanisms responsible for calcification in these valves. Recently, our laboratory and others have demonstrated that calcification in nonrheumatic, "degenerative" stenotic aortic valves removed at the time of surgical valve replacement is associated with an osteoblast-like phenotype.…”

Follow-up of rheumatic carditis treated with steroids

“…These data are similar to those described by several authors. 14,28,29 Some patients presented with rupture of chordae tendineae in the first rheumatic fever attack. These findings were previously reported, and chordae tendineae rupture is explained by the inflammatory reaction, Aschoff nodules consisting of central fibrinoid degeneration, and Anitschkow cells.…”

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

“…The carditis of ARF is a pancarditis, with valvulitis being the most common presentation [63]. It ranges widely in severity from mild sub-clinical involvement (16.8%) [64] to severe carditis with congestive heart failure and/or death (20%) [56].…”