Table 1.
Baseline characteristics of patients in three groups.
Fig 1.
Macroscopic appearances of representative excised aortic valves for aortic stenosis and regurgitation.
Tricuspid aortic valve stenosis (TAV-AS); Severe calcified sclerotic tricuspid valve with fused commissures is seen. Congenital bicuspid aortic valve stenosis (CBAV-AS); Two calcified cusps with raphe (black arrow) and severe fibrous thickening are seen. Congenital bicuspid aortic valve regurgitation (CBAV-AR); R (right coronary cusp) and L (left coronary cusp) are fused. Coaptation sites are rather thicker than the other portions (white arrow).
Fig 2.
Histological and immunohistochemical findings of aortic valve in TAV-AS, CBAV-AS, and CBAV-AR.
A: Inflammation; Inflammation with CD3 is seen in each group. More inflammatory cell infiltration is noted in TAV-AS and CBAV-AS compared with CBAV-AR. Red arrows indicate T cells infiltrations in valves. Upper photomicrographs are hematoxylin-eosin (H&E) staining, and lower photomicrographs are immunohistochemical staining for CD3. B: Neovascularization; Neovascularizations in TAV-AS and CBAV-AS are more intensive than those in CBAV-AR. Upper photomicrographs are H&E staining, and lower photomicrographs are immunohistochemical staining for von Willebrand factor (vWF). Blue arrows indicate the expression of vWF. C: Calcium deposition; The degrees of calcium deposition are higher in TAV-AS and CBAV-AS compared with CBAV-AR. Upper photomicrographs are Masson’s trichrome (MT) staining, and lower photomicrographs are immunohistochemical staining for osteopontin (OPN). Red arrows indicate the expression of osteopontin. D: Cholesterol deposition; The degrees of cholesterol deposition are higher in TAV-AS and CBAV-AS compared with CBAV-AR. Photomicrographs are H&E staining. E: Fibrosis; Valvular fibrosis is more severely noted in CBAV-AS compared with TAV-AS and CBAV-AR. Photomicrographs are MT staining. F: Immunohistochemical staining for tenascin-C. Red arrows indicate the expression of tenascin-C. Tenascin-C deposit is more diffuse and intensive in CBAV-AS valve.
Table 2.
Histopathological differences between the three groups.
Table 3.
Multivariate linear regression analysis of aortic valvular fibrosis in patients with severe AS.
Table 4.
Comparison of thickness of valve and fibrotic lesions.