What is the characteristic pathological change of rheumatic endocarditis

summary

Rheumatic endocarditis is the most important pathological change of rheumatic disease. It mainly involves the heart valve, causing valvulitis. It can also involve the endocardium and chordae tendineae adjacent to the valve, causing valve deformation and dysfunction. The disease mainly involved mitral valve, followed by mitral valve and aortic valve, tricuspid valve and pulmonary valve were rarely involved. So what is the characteristic lesion of rheumatic endocarditis? Do we really understand it? What is the characteristic pathological change of rheumatic endocarditis.

What is the characteristic pathological change of rheumatic endocarditis

The first is serous endocarditis in the early stage of the disease. A few weeks later, there are verrucous vegetations with a diameter of 1-2mm arranged in a single line on the edge of valve atresia. Therefore, this kind of endocarditis is also called verrucous endocarditis. Wart vegetation is gray white, translucent, firmly attached, generally not easy to fall off. Under the microscope, wart vegetation is white thrombus composed of platelets and cellulose. The warts mainly occurred in the atrial surface of the mitral valve and the ventricular surface of the aortic valve, and the left atrial wall also had thrombosis. In the late stage, the subendocardial lesions developed fibrosis and the warts were also organized. Because rheumatism often attacks repeatedly, scar formation is more and more. The endocardium of the left atrium can be thickened, rough and shrunk, especially in the posterior wall of the left atrium. Due to the repeated attack and organization of heart valve disease, a large number of connective tissue hyperplasia, resulting in valve thickening, curling, shortening and calcification, adhesion and fibrous healing between valve leaflets, thickening and shortening of chordae tendineae, eventually leading to the formation of chronic heart valve disease.

Second, macroscopic view shows that the valve involved in the early stage of the disease is swollen, thickened and tarnished, and then the valve is constantly impacted by the blood flow and constantly closed and opened by friction, resulting in the damage of the valve surface, especially the intima at the edge of atresia, forming a rough surface, resulting in the deposition and agglutination of blood platelets, forming a beaded single row, the size of which is like millet (1 ~ 3mm), Grayish white, translucent, verrucous vegetation that adheres firmly to the valve and is not easy to fall off.

Third: in the late stage of the disease, the subendocardial rheumatic lesions developed fibrosis, and the vegetations in the heart valve and chordae tendineae were organized to form gray scars. It leads to valve thickening, hardening, curling and shortening, fibrous adhesion between leaflets, thickening and shortening of chordae tendineae, eventually leading to valve disease (valve stenosis and / or valve insufficiency), hemodynamic changes and even heart failure. The posterior wall of the left atrium may be thickened, roughened and shrunk by organization, which is called McCallum patch.

matters needing attention

In rheumatic endocarditis, heart murmur, hypertrophy of atrium and ventricle, dilation, systemic congestion and other heart failure may occur due to valve deformation caused by repeated attacks of the disease.