PMC5266148_01
Mitral valve: Panel A: Atrial aspect of the mitral valve - both AV and PV are markedly thickened by fibrosis without calcifications. Note the commissural fusion. The gross pathology is typically a rheumatism-like pattern. Panel B: The subvalvular apparatus shows that the chordae tendinae are severely involved presenting fibrous thickening, fusion, and shortening. Panel C: Gross pattern of the aortic cusps showing uneven thickening of the valve (millimeter scale). Panel D: Histopathology of the mitral valve - the structure of the valve is preserved. The endocardium is thickened by fibrosis (arrows). H&E stain. Original x2.5. Panel E: Histopathology of the mitral valve - elastic stain showing clearly the endocardial fibrosis (arrows). Elastic stain. Original x2.5. Aortic valve: Panel F: Histopathology of a cusp in a thickened area - the structure of the valve is preserved. The endocardium is thickened by fibrosis (arrow). H&E stain. Original x2.5. Panel G: Histopathology of a cusp - elastic stain showing clearly the endocardial fibrosis (arrow) occupying a half of the valve thickness. Elastic stain. Original x2.5. AV = anterior valve, PV = posterior valve.
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F1
Peroperative findings were severely enlarged pulmonary trunk, noncalcified funnel-shaped mitral apparatus associated with leaflet thickening and commissural fusion (Fig. 1, panels A, B). In contrast aortic leaflets were thin with noncoronary cusp prolapse (Fig. 1, panel C). Pathology examination demonstrated drug-induced valvular disease by demonstrating noninflammatory endocardial fibrosis on both mitral (Fig. 1, panels D, E) and aortic valves (Fig. 1, panels F, G).