Aortic stenosis microscopic pathology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Aysha Anwar, M.B.B.S[2]

Common findings on microscopic pathologic evaluation in the patient with aortic stenosis include left ventricular hypertrophy and calcific degneration of the aortic valve.

• The calcified aortic stenosis shows pink amorphous material around the calcific foci indicating deposition of calcium.^[1]
• The microscopic features of congenital and calcific aortic stenosis include the areas of fibrosis, thickening, fat cell infiltration and elastosis.^[1]

A 68-year-old man initially sought medical advice five years prior to his death. His symptoms at that time were exercise intolerance and occasional peripheral edema. He gave a history of a heart murmur that was diagnosed 25 years ago during an employment physical. No follow up care had been given for this murmur.

The patient’s terminal admission was for signs of severe heart failure – the patient had marked peripheral edema and shortness of breath and chest x-ray revealed significant cardiac enlargement and pulmonary edema with bilateral pleural effusions. He sustained a cardiac arrest shortly after admission and could not be resuscitated.

Autopsy disclosed a markedly enlarged heart weighing 650 grams and having dilated chambers. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found and there was no evidence of myocardial infarction.

• 
  This is a gross photograph of a cross section of a normal human heart taken at autopsy (right) and the heart from this case, which demonstrates concentric hypertrophy of the left ventricular wall. Note the marked thickening of the left ventricular wall. There is also moderate thickening of the right ventricular wall.
• 
  This low-power photomicrograph shows normal myocardium (left) compared to hypertrophied myocardium (right).
• 
  Normal myocardium (left) is compared here to hypertrophied myocardium (right). The muscle fibers are thicker and the nuclei are larger and darker in the hypertrophied myocardium.The clear spaces between the muscle fibers are due to processing artifacts and are not present during life.
• 
  Normal myocardium (left) is compared to hypertrophied myocardium (right). This high power view demonstrates the large dark nuclei (arrow) found in hypertrophied cardiac muscle cells. Polyploidy is a common feature in cardiac hypertrophy. Also note the increased size (thickness) of the individual cardiac muscle cell on the right compared to normal cardiac myocytes (left).

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