The Frequency of Aschoff Bodies in Atrial Appendages of Patients with Mitral Stenosis

Abstract

Three hundred and sixteen biopsies of atrial appendages obtained at mitral valvotomy were studied histologically. They were divided into those with Aschoff bodies (41 per cent), those with nonspecific granulomas (23 per cent), and those without either lesion. These findings were compared with those of previous investigators. A study of 24 hearts with mitral stenosis and survey of the literature showed that Aschoff bodies in the left atrial appendage are usually accompanied by similar lesions in the rest of the heart. The average age of patients with Aschoff bodies in their atrial biopsy was 4 years less than that of those with "nonspecific granulomas" and more than 7 years less than that of patients without inflammatory foci in the endocardium. The etiology of "nonspecific granulomas" is discussed. Aschoff bodies were rare in patients with organized atrial thrombi, most of whom were fibrillating. Statistical analysis showed that thrombosis rather than fibrillation was the principal factor associated with a lowered incidence of Aschoff bodies. It was concluded that mechanical factors may determine the localization of rheumatic lesions in the heart. Elevated sedimentation rates were recorded as often in patients with negative biopsies as in those with Aschoff bodies. The percentage of positive biopsies fell from 66 per cent in patients aged 15 to 20 years to 14 per cent in patients aged over 55 years. The age incidence of Aschoff bodies has been compared with that of acute rheumatic fever, which is rare after the age of 15 years. It is concluded that in patients with mitral stenosis, histologic activity may continue for 20 years or more in the absence of clinical signs and symptoms. The proportion of positive biopsies was lowest in June and maximal in September. This seasonal change suggests that the histologic process is only intermittently active. The seasonal variation in the percentage of Aschoff bodies is discussed in relation to the seasonal incidence of acute rheumatic fever. Our results appear to establish the concept of a "subclinical" rheumatic process which has been postulated by many previous investigators.

Long‐Term Outcome Following Ablation of Atrial Tachycardias Occurring after Mitral Valve Replacement in Patients with Rheumatic Heart Disease

“…Several studies have demonstrated the occurrence of ultrastructural changes resulting in fibrosis in the atria of patients with RHD . A pathognomonic feature of rheumatic carditis is the Aschoff bodies . Such inflammatory tissue can arise during an acute episode of carditis and remain immunologically active for years.…”

“…17,18 A pathognomonic feature of rheumatic carditis is the Aschoff bodies. 19 Such inflammatory tissue can arise during an acute episode of carditis and remain immunologically active for years. They have been associated with the local release of a variety of cytokines, including many that are implicated in fibrogenesis.…”

Outcome of tailored therapy in rheumatic heart disease with persistent atrial fibrillation (RHD‐AF)

“…They demonstrated both structural and electrical biatrial abnormalities in these cases. These patients are reported to have direct myocardial fibrosis and inflammation in both the right and LA related to carditis apart from hemodynamic consequences from valvular disease 34–38 . Thus, we cannot manage these cases with mere PVI as we do in NVAF.…”

Incidental Histological Diagnosis of Acute Rheumatic Myocarditis: Case Report and Review of the Literature

“… n/a, not available . a There were missing data on age in 2 patients in the paper by Decker et al ( 6 ) and in 21 patients in the paper by Ruebner et al ( 19 ) . …”