fibrin and Aortic-Valve-Insufficiency

A role of coagulation in the pathogenesis of aortic stenosis (AS) is unknown. The aim of this study was to investigate the fibrin (Fn) presence and its determinants in calcified stenotic aortic valve leaflets. Twenty-one patients with dominant AS and 17 well-matched patients with dominant aortic insufficiency (AI) undergoing aortic valve replacement were studied. Immunofluorescence analysis was performed on decalcified leaflets using antibodies against human Fn and tissue factor (TF). Fn-positive (41.4%) and TF-positive (25.3%) areas were increased in AS valves compared with AI valves (7.9% and 5.9%, respectively, both p<0.001). Patients with AS had elevated plasma D-dimer (236.4 ± 28 ng/ml, p=0.002) and prothrombin fragment 1+2 (F1.2) (261.7 ± 27.1 pM, p=0.005) compared to AI subjects (142.8 ± 10 ng/ml and 131.2 ± 1.3 pM, respectively). In AS patients Fn-positive areas correlated with TF-positive areas (r=0.68, p=0.0005), D-dimer (r=0.45, p=0.018), F1.2 (r=0.64, p=0.002), the time required for plasma fibrin clot formation (r=0.44, p=0.015) and maximum absorbance of fibrin clots (r=-0.38, p<0.0001), but not with clot permeability or lysis time. Thickness of Fn layer within AS valves was associated with maximum transvalvular gradient (r =0.41, p=0.048). Patients with maximal gradient above 75 mmHg (n=11) showed significant associations between Fn-positive area and both maximal (r =0.63) and mean (r =0.67) transvalvular gradients. Large fibrin amounts, mostly co-localised with TF, are present within the valve leaflets of patients with advanced AS. In vivo thrombin generation and fibrin clot formation are associated with the extent of Fn presence within leaflets, which might contribute to the AS progression.

Topics: Aged; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Biomarkers; Blood Coagulation; Calcinosis; Chi-Square Distribution; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fluorescent Antibody Technique; Humans; Male; Middle Aged; Peptide Fragments; Poland; Prothrombin; Severity of Illness Index; Thrombin; Thromboplastin; Ultrasonography

A case of infective endocarditis which was complicated with hemorrhagic fibrinous pericarditis was reported. The hemorrhagic fibrinous pericarditis is a rare complication of infective endocarditis of the aortic root and is observed massive hemorrhage into the pericardial space. These patients should be considered for the aortic valve replacement early in the course of the disease.

Topics: Aortic Valve; Aortic Valve Insufficiency; Endocarditis, Bacterial; Fibrin; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Pericarditis

Sixteen frame-mounted fascia lata valves removed from the mitral, aortic or--in one patient--pulmonary position have been detailed histologically. These valves had remained in 15 patients (11 men and four women) for periods varying between 10 and 44 months. The reason for the original transplantation was either chronic rheumatic endocarditis or calcific aortic disease. In the mitral position, the leaflet in position nearest the site of the original anterior mitral valve cusp showed the least changes. The remaining two leaflets of the fascia lata valve in the mitral position, as well as those removed from the aortic or pulmonary position, showed more severe changes; these consisted of degeneration of collagen tissue and often a severe decrease of nuclei belonging to the fibroblastic series. These changes, as well as superimposition of fibrin or fibrous tissue, tended to become more pronounced the longer the valve had remained in the patient. Viability studies in valves removed from two patients have also been undertaken showing very greatly reduced activity. The possible causes for valve dysfunction have been reviewed, and the findings in this study suggest that contraction of fibrous tissue, which sandwiches the fascia lata valve cusps, may contribute to failure of satisfactory valve function. It is concluded that fascia lata forms a poor substitute for replacement of diseased cardiac valves.

Topics: Adult; Aortic Valve; Aortic Valve Insufficiency; Cell Nucleus; Collagen; Eosinophils; Fascia; Fascia Lata; Female; Fibrin; Fibroblasts; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Pulmonary Valve; Thymidine; Time Factors; Tissue Survival

Topics: Aortic Valve; Aortic Valve Insufficiency; Evaluation Studies as Topic; Fascia; Fascia Lata; Fibrin; Follow-Up Studies; Heart Valves; Humans; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Transplantation, Autologous; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Adult; Aortic Valve; Aortic Valve Insufficiency; Aortography; Blood Vessel Prosthesis; Cardiac Catheterization; Extracorporeal Circulation; Fibrin; Humans; Male; Postpericardiotomy Syndrome

Topics: Adolescent; Adult; Aortic Valve Insufficiency; Biological Assay; Blood Coagulation; Cardiac Surgical Procedures; Child; Child, Preschool; Extracorporeal Circulation; Female; Fibrin; Fibrinolysis; Heart Septal Defects; Hemorrhage; Humans; Male; Middle Aged; Mitral Valve Insufficiency