title: Histopathological Study of Left and Right Atria in Isolated Rheumatic Mitral Stenosis With and Without Atrial Fibrillation.
abstract: Mitral stenosis (MS) has the highest incidence of atrial fibrillation (AF) in chronic rheumatic valvular disease. There are very few studies in isolated MS comparing histopathological changes in patients with sinus rhythm (SR) and AF.
  
  
  
  To analyze the histological changes associated with isolated MS and compare between changes in AF and SR.
  
  
  
  This was a prospective study in patients undergoing valve replacement surgery for symptomatic isolated MS who were divided into 2 groups, Group I AF (n = 13) and Group II SR (n = 10). Intra-operative biopsies performed from 5 different sites from both atria were analyzed for 10 histopathologic changes commonly associated with AF.
  
  
  
  On multivariate analysis, myocytolysis (odds ratio [OR]: 1.48, P = 0.05) was found to be associated with AF, whereas myocyte hypertrophy (OR: 0.21, P = 0.003), and glycogen deposition (OR: 0.43, P = 0.002) was associated with SR. Interstitial fibrosis the commonest change was uniformly distributed across both atria irrespective of the rhythm.
  
  
  
  In rheumatic MS, SR is associated with myocyte hypertrophy whereas AF is associated with myocytolysis. Endocardial inflammation is more common in left atrial appendage irrespective of rhythm. Interstitial fibrosis is seen in >90% of patients distributed in both the atria and is independent of the rhythm. Amyloid and Aschoff bodies are uncommon and the rest of the changes are uniformly distributed across both the atria.
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. jshenthar@yahoo.com.
authors.forename: Jayaprakash
authors.initials: J
authors.lastname: Shenthar
authors.affiliation: Department of Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Saligrama Ramegowda
authors.initials: SR
authors.lastname: Kalpana
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Mukund A
authors.initials: MA
authors.lastname: Prabhu
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Maneesh K
authors.initials: MK
authors.lastname: Rai
authors.affiliation: Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Ravikumar Kalyani
authors.initials: RK
authors.lastname: Nagashetty
authors.affiliation: Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Giridhar
authors.initials: G
authors.lastname: Kamlapurkar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D001706:Biopsy; D006332:Cardiomegaly / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006003:Glycogen / Q000032:analysis; D006325:Heart Atria / Q000737:chemistry / Q000473:pathology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006003:Glycogen
keywords: atrial fibrillation; atrial pathology; histopathology; mitral valve replacement; rheumatic mitral stenosis