Effects of calcific and inflamatory mechanisms on different aortic cusps in ethyopathogenesis of aortic stenosis

Pathophysiological processes that initiate calcific aortic stenosis are still undefined and there are no currently available treatments that effect disease progression. The aim of this study was to evaluate pathologically, aortic valve cusps of patients with AS who went through aortic valve replacement in Celal Bayar University, Department of Cardiovascular Surgery. Removed aortic valves were seperated into left-coronary, right-coronary and non-coronary cusps and stablized in %10 formalin solution. When 60 cusps were obtained from 20 aortic valves, the specimens were numbered 1-60 and sent to the pathology laboratory. Pathology department was blinded while the surgery department knew the source of the cusps. 5 mm thick sections were taken from the specimens by rotary microtom and stained with Hematoxylin & Eosin (H&E) and Van Gieson stains. H&E stained slides were examined with standard light microscope for calcification, fibrosis and inflammation by a blinded pathology specialist. Cusps were compared with each other as Right-Left, Right-Non and Left-Non coronaries. As a result of this comparison there was no statistically significant difference in terms of inflammation between Left-Right, Right-Non and Left-Non Coronary cusps (p values were 0.199, 0.789, 0.379 respectively). In terms of fibrosis comparison of Left-Right and Right-Non coronary cusps did not show any statistically significant difference (p values were 0.079, 0.880 respectively) while Left-Non coronary cusp comparison showed statistically significant difference (p=0.046). In terms of calcification comparison of Left-Right and Right-Non coronary cusps did not show any statistically significant difference (p values were 0.285, 0.180 respectively) while Left-Non coronary cusp comparison showed statistically significant difference (p=0.011). Although pathological difference between aortic cusps rarely take part in current literature, we believe that it may supply some new information to medical and surgical treatment of calcific aortic stenosis. Key words: Aortic Stenosis, Calcification, Fibrosis, Inflammation