Subclinical Endocarditis Might be a Hidden Trigger of Early Prosthetic Valve Calcification: A Histological Study

  • Tamer Ghazy Department of Cardiac Surgery, Dresden Heart Center, Dresden University of Technology,Dresden, Germany
  • Claudia Dittfeld Department of Cardiac Surgery, Faculty of Medicine CGC, Technische Universität Dresden, Herzzentrum Dresden, Dresden,Germany
  • Anett Jannasch Department of Cardiac Surgery, Faculty of Medicine CGC, Technische Universität Dresden, Herzzentrum Dresden, Dresden,Germany, Dresden,Germany
  • Michael Haase Research Laboratory, Department of Pediatric Surgery, University Hospital Carl Gustav Carus, TU, Dresden, Germany
  • Roberta Galli Department of Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring, Faculty of Medicine CGC, Technische Universität Dresden, Dresden, Germany
  • Katrin Plötze Department of Cardiac Surgery, Dresden Heart Center, Dresden University of Technology,Dresden, Germany
  • Thomas Waldow Department of Cardiac Surgery, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
  • Klaus Matschke Department of Cardiac Surgery, Dresden Heart Center, Dresden University of Technology, Dresden, Germany

Abstract

Objective: Despite various improvements in valve prosthetics, early valve deterioration still occurs, leading to prosthetic failure. Studying the early phase of this deterioration is quite difficult, as the prosthesis to be examined is almost always explanted only after extensive deterioration. The objective of this research is to study the pathology of early valve deterioration in an early stage in order to reveal the possible trigger of the process.

Methods: Three cusps of the same type of bovine pericardium valve prosthesis underwent comparative examination. Two cusps (cusps 1 and 2) were retrieved from a valve prosthesis explanted three months post-implantation, and the third cusp was from a non-implanted valve prosthesis and used as a reference cusp (ref. cusp). The examination included macroscopic examination, Non-linear Optical Microscopy using a multiphoton microscope, and histological examination with staining, using Hematoxylin and Eosin, Movat Pentachrome stain, Von-Kossa stain, and Alizirin-Red stain. Parallel sections were decalcified using Osteosoft® solution prior to Von-Kossa and Alizirin-Red staining to exclude false positive results.

Results: Macroscopically, cusp 1 showed early deterioration, and cusp 2 showed endocarditic vegetations. Histologically, cusp 1 showed calcifications in acellular deposits on the surface of the cusp, with pathological signs of subacute/healed endocarditis and intact cusp tissue. The examination did not show calcifications of the cellular remnants within the valve tissue. Cusp 2 showed florid endocarditis, with microscopic destruction of the valve tissue.

Conclusion: Early prosthetic valve deterioration can exist as early as three months post-implantation. Subacute or subclinical endocarditis can be the cause for early valve calcification and deterioration.

References

Böck P. 1989. Romeis: Mikroskopische Technik. München: Urban & Schwarzenberg.

Büttner P, Galli R, Jannasch A, et al. 2014. Heart valve stenosis in laser spotlights: insights into a complex disease. Clin Hemorheol Microcirc 58:65-75.

Cremer PC, Rodriguez LL, Griffin BP, et al. 2015. Early bioprosthetic valve failure: A pictorial review of rare causes. JACC Cardiovasc Imaging 8:737-40.

Ferrans VJ, Boyce SW, Billingham ME, et al. 1980. Calcific deposits in porcine bioprostheses: structure and pathogenesis. Am J Cardiol 46:721-34.

Ferrans VJ, Boyce SW, Billingham ME, et al. 1978. Infection of glutaraldehyde-preserved porcine valve heterografts. Am J Cardiol 43:1123-36.

Flameng W, Herregods MC, Vercalsteren M, et al. 2010. Prosthesis-patient mismatch predicts structural valve degeneration in bioprosthetic heart valves. Circulation 121:2123-9.

Galli R, Uckermann O, Koch E, et al. 2014. Effects of tissue fixation on coherent anti-Stokes Raman scattering images of brain. J Biomed Opt 19:071402.

Hetzer R, Hill JD, Kerth WJ, et al. 1978. Thrombosis and degeneration of Hancock valves: clinical and pathological findings. Ann Thorac Surg 26:317-22.

Ishihara T, Ferrans VJ, Jones M, et al. 1981. Calcific deposits developing in a bovine pericardial bioprosthetic valve 3 days after implantation. Circulation 63:718-23.

Pettenazzo E, Valente M, Thiene G. 2008. Octanediol treatment of glutaraldehyde fixed bovine pericardium: evidence of anticalcification efficacy in the subcutaneous rat model. Eur J Cardiothorac Surg 34:418-22.

Schoen FJ, Levy RJ. 2005. Calcification of tissue heart valve substitutes: progress toward understanding and prevention. Ann Thorac Surg 79:1072-80.

Sénage T, Le Tourneau T, Foucher Y, et al. 2014. Early structural valve deterioration of Mitroflow aortic bioprosthesis: mode, incidence, and impact on outcome in a large cohort of patients. Circulation 130:2012-20.

Uckermann O, Galli R, Beiermeister R, et al. 2015. Endogenous two-photon excited fluorescence provides label-free visualization of the inflammatory response in the rodent spinal cord. Biomed Res Int 2015:859084.

Published
2018-07-02
Section
Articles