Sezen KOÇARSLAN, Aydemir KOÇARSLAN, Mehmet KİRİŞÇİ, Erdinç EROĞLU, Mehmet ACİPAYAM, Alptekin YASIM

Kalp Kapakları Bize ne Diyor?

Amaç: Çalışmamızın amacı dejeneratif kalp kapak hastalıkları nedeniyle eksize kalp kapakçıklarının histopatolojik değişikliklerini araştırmaktır.Materyal ve metotlar : Dejeneratif kalp kapağı hastalığı olan 40 hastadan eksize edilen 28 tane aort kapağı ile 20 tane mitral kapak retrospektif olarak araştırmaya dahil edildi. 8 hastadan hem aort hem mitral kapak eksize edilmiştir. Hastalara ait klinik diagnostik bilgiler hastane bilgi sisteminden elde edildi. Kalp kapakları standart histopatolojik metotlar kullanılarak parafine gömüldü ve her bloktan 3-4 μm kalınlığında kesitler alındı. Hematoksilen Eozin ile boyalı preparatlar Olympus BX51 mikroskopu ile histopatolojik değişiklikler açısından değerlendirildi. Her vakanın mevcut histopatolojik slaytları orijinal tanıyı doğrulamak ve çeşitli mikroskobik değişikliklerin değerlendirmesini sağlamak için bağımsız olarak gözden geçirildi.Bulgular: Hastaların 21(% 53)’ i erkek, 19(% 47)’ u kadındı. Hastaların yaş aralığı 20-88 idi. Ortalama yaş 59 olarak hesaplandı. Kadınların yaş ortalaması 60.7, erkeklerin yaş ortalaması 57.5 idi. Hastane bilgi sisteminden edinilen verilere göre hastaların 14 (% 35)’ünde hipertansiyon, 12 (% 30)’sinde hiperlipidemi, 9 (% 23)’unda diyabetes mellitus, 10 (% 25)’unda sigara öyküsü 6 (% 15)’sında koroner arter hastalığı mevcuttu. Fokal alanlarda normal histolojik yapının da seçilebildiği kapakların tamamında (% 100) değişen derecelerde fibrozis mevcuttu . 32 kapakta (% 67) kalsifikasyon mevcuttu . Altı kapakta (% 13) kemik ve kartilaj oluşumu birlikte izlendi . Kemik ve kartilaj oluşumu izlenen kapakların 4 (% 8)’ü aort, 2 (%4)’si mitral kapaktı. Tüm kemik oluşumu alanlarına kalsifikasyon da eşlik etmekteydi. Kemik metaplazisi görülme yaş ortalaması 60.8 idi. 27 kapakta (% 56) kronik inflamasyon, 11 kapakta (% 23) neoanjiogenezis ve bir kapakta (% 2) endokardite bağlı nekroz ve abse formasyonu izlendi Kronik inflamasyonun lenfositler ve plazma hücrelerinden oluştuğu görüldü. Sonuç: Kalp kapak dejenerasyonları kardiyovasküler risk faktörleri ile yakından ilişkilidir. Çok basamaklı moleküler yolaklar aracılığıyla gelişen aktif bir süreçtir. Kapak interstisyel hücreleri bu süreçteki başrol oyuncusudur.

Anahtar Kelimeler:

KALP KAPAKLARI, DEJENERASYON, HİSTOPATOLOJİ

What Do the Heart Valves Tell Us?

Background: The aim of our study was to investigate the histopathological changes of excised cardiac valves due to degenerative heart valve diseases.Methods: We collected and explored the histopathologic changes in 28 aortic valves and 20 mitral valves from 40 patients with Acquired Heart Valve Disease retrospectively. Both aorta and mitral valve were excised from 8 patients. Clinical diagnostic information about the patients was obtained from the hospital information system. Fragments of cardiac valve were processed using standard histopathological methods and embedded in paraffin tissue blocks. From each block, 3–4 μm-thick histological sections were cut and stained with hematoxylin-eosin. Slides stained with hematoxylin-eosin were evaluated under Olympus BX51 microscope for histopathological changes. In each case, the available histopathological slides were independently reviewed to confirm the original diagnosis and provide assessment of the various microscopic changes.Results: 21 (53%) of the patients were male and 19 (47%) were female. The age range of the patients was 20-88. The average age was calculated to be 59. The average age of women was 60.7 and the average age of men was 57.5. According to the data obtained from the hospital information system, hypertension in 14 (35%), hyperlipidemia in 12 (30%), diabetes in 9 (23%), smoking history in 10 (25%) and coronary artery disease in 6 (15%) were present. There were varying degrees of fibrosis in all of the valves (100%) in which the normal histological structure was also observed in the focal areas. Calcification was present on 32 valves (67%) . Six valves (13%) showed both bone and cartilage formation. The valves which exhibit bone and cartilage formation were 4 valves (8%) aorta and 2 valves (8%) mitral valve. All areas of bone formation were accompanied by calcification. The average age of bone metaplasia was 60.8. Chronic inflammation was observed in 27 valves (56%). Neoangiogenesis in 11 valves (23%) and necrosis and abscess formation due to endocarditis in one valve (2%) were observed. Chronic inflammation consisted of lymphocytes and plasma cells. Conclusion: Heart valve degenerations are closely associated with cardiovascular risk factors. it is an active process that develops through multi-step molecular pathways. Valve interstitial cells are the lead player in this process.

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