Abstract
Native cardiac valves may undergo calcification in the setting of chronic injury, subsequently impeding normal valve structure and function. In the same setting, there may be evidence of metaplasia—specifically osseous metaplasia—with lamellar bone admixed with dystrophic calcification. In this study, the histologic features of 123 native aortic valves (identified from 1094 sequentially reviewed native valves of all types that included a total of 754 aortic valves) with osseous metaplasia are focused upon, as well as correlation with other histopathologic features, and clinical and echocardiographic findings. Osseous metaplasia was identified in aortic and significantly less frequently in mitral valves, and never in tricuspid or pulmonic valves. Notable observations included that osseous metaplasia in aortic valves were seen in patients with greater body mass index, and less commonly identified in patients with a history of autoimmune disease. Aortic valves with osseous metaplasia were more commonly tricuspid (as opposed to bicuspid), and with smaller aortic valve area and greater peak and mean gradients. The rate of osseous metaplasia in aortic valves increased with increasing degree of stenosis and decreasing degree of regurgitation. The rates of the presence of chondromatous metaplasia, smooth muscle, arterial vessels, capillary bed formation, chronic inflammation, and hemosiderin laden macrophages were greater in aortic valves with osseous metaplasia compared to valves without osseous metaplasia. Further investigation is required to determine potential physiologic and/or pathologic consequence of the presence of valvular osseous metaplasia.
Similar content being viewed by others
References
Schoen FJ (2005) Cardiac valves and valvular pathology: update on function, disease, repair, and replacement. Cardiovasc Pathol 14:189–194
Cote N, Mahmut A, Bosse Y, Couture C, Page S, Trahan S et al (2013) Inflammation is associated with the remodeling of calcific aortic valve disease. Inflammation 36:573–581
Galli D, Manuguerra R, Monaco R, Manotti L, Goldoni M, Becchi G et al (2017) Understanding the structural features of symptomatic calcific aortic valve stenosis: a broad-spectrum clinico-pathologic study in 236 consecutive surgical cases. Int J Cardiol 228:364–374
Mohler ER 3rd, Gannon F, Reynolds C, Zimmerman R, Keane MG, Kaplan FS (2001) Bone formation and inflammation in cardiac valves. Circulation 103:1522–1528
Steiner I, Kasparova P, Kohout A, Dominik J (2007) Bone formation in cardiac valves: a histopathological study of 128 cases. Virchows Arch 450:653–657
Torre M, Hwang DH, Padera RF, Mitchell RN, VanderLaan PA (2016) Osseous and chondromatous metaplasia in calcific aortic valve stenosis. Cardiovasc Pathol 25:18–24
Warren BA, Yong JL (1997) Calcification of the aortic valve: its progression and grading. Pathology 29:360–368
PichlerSekulic S, Sekulic M (2021) Adipocytes and membranous fat necrosis within native cardiac valves Clinicopathologic characterization of histologic constituents. Cardiovasc Pathol 50:107276
Bansal M, Sengupta PP (2017) How to interpret an echocardiography report (for the non-imager)? Heart 103:1733–44
Brennan DC, Agha I, Bohl DL, Schnitzler MA, Hardinger KL, Lockwood M et al (2005) Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction. Am J Transplant 5:582–594
Fishbein GA, Fishbein MC (2019) Pathology of the aortic valve: aortic valve stenosis/aortic regurgitation. Curr Cardiol Rep 21:81
Author information
Authors and Affiliations
Contributions
MS provided patient care and contributed to the preparation of the manuscript.
Corresponding author
Ethics declarations
Ethics approval
This was performed in accordance with research policies approved by the Institution Review Boards of the author’s institution.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pichler Sekulic, S., Sekulic, M. Osseous metaplasia within native cardiac valves: clinicopathologic characterization of a histologic constituent with particular focus upon aortic valves. Virchows Arch 480, 425–432 (2022). https://doi.org/10.1007/s00428-021-03200-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-021-03200-8