Bone formation and inflammation in cardiac valves
Bone formation and inflammation in cardiac valves
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DOI：
10.1161/01.cir.103.11.1522
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发表时间：
2001-03-20
期刊：
影响因子：
37.8
通讯作者：
Kaplan, FS
中科院分区：
文献类型：
--
作者：
Mohler, ER;Gannon, F;Kaplan, FS
近一个世纪以来，钙化心脏瓣膜的机械故障被认为是一种被动的退行性过程。最近，一些病例报告描述了手术切除心脏瓣膜的骨形成，并提出了一个意想不到的组织修复过程。方法与结果：我们研究了1994年至1998年间324例连续接受心脏瓣膜置换术的347例手术切除的心脏瓣膜（256例主动脉瓣，91例二尖瓣）的异位骨化的患病率和病理学，其中男性182例，女性142例，平均年龄68岁。我们对瓣膜进行了显微镜检查以确定骨形成和重塑的患病率和特征。288例（83%）瓣膜发生营养不良钙化。36例（13%）瓣膜存在营养不良钙化的成熟板层骨，具有造血因子和骨重塑活性。在4个瓣膜中发现了与正常骨折修复相似的软骨内骨形成。所有骨化瓣膜中有92%存在微骨折，所有骨化瓣膜中均有新生血管生成。骨形态发生蛋白2和4 （BMP 2/4）是一种强效的成骨形态因子，在B淋巴细胞和t淋巴细胞浸润的瓣膜附近的肌成纤维细胞和成骨前细胞中表达。肥大细胞存在于钙化和骨化的瓣膜中，在动脉粥样硬化区域尤为突出。结论：由成熟板层骨形成和活跃骨重塑组成的异位骨化是终末期瓣膜性心脏病中相对常见和意想不到的发现，可能与钙化心脏瓣膜病理性微骨折的修复有关。
Background-For nearly a century, the mechanical failure of calcified heart valves was attributed to a passive degenerative process, Recently, several case reports described bone formation in surgically excised heart valves and suggested an unexpected process of tissue repair.Methods and Results-We studied the prevalence and pathology of heterotopic ossification in 347 surgically excised heart valves (256 aortic, 91 mitral) in 324 consecutive patients (182 men, 142 women; mean age 68 years) who underwent cardiac valve replacement surgery between 1994 and 1998, The valves were examined microscopically to determine the prevalence and features of bone formation and remodeling. Two hundred eighty-eight valves (83%) had dystrophic calcification. Mature lamellar bone with hematopoietic elements and active bone remodeling were present in 36 valves (13%) with dystrophic calcification. Endochondral bone formation, similar to that seen in normal fracture repair, was identified in 4 valves. Microfractures were present in 92% of all valves with ossification, Neoangiogenesis was found in all valves with ossification. Bone morphogenetic proteins 2 and 4 (BMP 2/4), potent osteogenic morphogens, were expressed by myofibroblasts and preosteoblasts in areas adjacent to B- and T-lymphocyte infiltration in valves where ossification was identified, Mast cells were present in calcified and ossified valves and were especially prominent in atheromatous regions.Conclusions-Heterotopic ossification consisting of mature lamellar bone formation and active bone remodeling is a relatively common and unexpected finding in end-stage valvular heart disease and may be associated with repair of pathological microfractures in calcified cardiac valves.