A 68-year-old man presents with exertional dyspnea and syncope. Cardiac auscultation reveals a harsh crescendo-decrescendo systolic murmur best heard at the right upper sternal border radiating to the carotid arteries. Echocardiography shows a calcified aortic valve with reduced orifice area. Which histological change is most characteristic of the early lesion of his underlying condition?
- A Fibrin deposits with Aschoff bodies
- B Vegetations with bacterial colonies and neutrophilic infiltrate
- C Lipid accumulation and inflammation at the valve commissures ✓
- D Myxomatous degeneration with mucopolysaccharide accumulation
Correct answer: C. Lipid accumulation and inflammation at the valve commissures
Explanation
Calcific aortic stenosis shares pathogenic features with atherosclerosis. The early lesion involves lipid accumulation, chronic inflammation, and activation of valve interstitial cells at the valve commissures and bases, similar to early atherosclerosis. This progresses to calcification and fibrosis. Aschoff bodies are seen in rheumatic heart disease. Bacterial vegetations characterize infective endocarditis. Myxomatous degeneration is seen in mitral valve prolapse. Robbins 10th ed, Chapter 12.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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