MORPHOLOGICAL AND HISTOLOGICAL CHARACTERISTICS OF SURGICALLY EXCISED MITRAL VALVE IN PATIENTS WITH RHEUMATIC AND NONRHEUMATIC MITRAL VALVE DISEASE

Dr. Md. Imran*, Dr. Shakhawat Hossain, Dr. Lubna Baset Bristi, Dr. MST. Nadia Yousuf and
Dr. Tahmina Haque

ABSTRACT

Background: Among the rheumatic valvular heart disease; Mitral valve is frequently affected. In the past years, the pathology of cardiac valves has been thoroughly studied at autopsy. Now valve specimen obtained during cardiac surgery allow the study of a greater number of valves which affected by different diseases. Thus, the gross morphological study and histological examination of the surgically excised mitral valves will enhance the knowledge about the nature of rheumatic and nonrheumatic valve diseases. An understanding of the abnormal structure of the mitral valve is critical in choosing the optimal therapeutic approach for affected individuals. Objective: To see morphological and histological characteristics of surgically excised mitral valve in rheumatic and nonrheumatic mitral valve diseases and compare this characteristic between rheumatic and nonrheumatic mitral valve disease. Materials and Methods: This comparative cross sectional study carried out in the department of cardiac surgery, NICVD from first August 2018 to thirteen June 2020. Total 60 patients selected irrespective of age and sex. This patient gone through mitral valve replacement surgery. Results: Total sixty patients selected irrespective of age and sex who underwent through routine mitral valve replacement surgery. Based on past history of rheumatic fever patients divided into two group Rheumatic and nonrheumatic mitral valve disease. Among 60 patients 31(51.67%) were male and 29 (48.33%) were female. Among male, 20 (33.33%) male patients in rheumatic group and 11 (18.33%) male patients in nonrheumatic group. Among female, 24 (40%) female patients in rheumatic group and 5 (8.33%) female patients in nonrheumatic group. Morphological study revealed thickening and fibrosis to varying extent present in 48 (80%) cases. Commissural fusion and reduction of valve area present in 36 (60%) patients, Annular dilatation present in 16 (26.67%) cases, Calcium deposition to varying extent present in 39 (65%) patients, sub valvular changes present in 52 (86.66%) patients. The differences of morphological features were statistically significant (p<0.05) in Chi-Square test (χ2). Morphological study of valve revealed mitral valve is more distorted and had more features than preoperative echocardiography. Histological study revealed among 60 patient fibrosis found in 48 (80%) slide, calcium deposition found in 42 (70%) cases. Aschoff body found in 32 (53.33%) patients, few specimens revealed multinucleated Aschoff giant cell. Differences between rheumatic and non-rheumatic groups was statistically significant (p<0.05). Conclusion: In this study, based on morphologic and histologic features of diseased mitral valve following mitral valve replacement procedure, it can be concluded that in national institute of cardiovascular diseases most mitral valve replacement procedure occur due to Rheumatic mitral valve disease than nonrheumatic mitral valve disease.

Keywords: Mitral Stenosis; Mitral Regurgitation; Rheumatic valvular Heart disease; Non Rheumatic Valvular Heart Disease; Mitral Valve Replacement; Morphology; Histopathology.