title: Lymphangiogenesis is increased in heart valve endocarditis.
abstract: BACKGROUND
  Inflammation-associated lymphangiogenesis (IAL) has been identified as part of several acute and chronic inflammation. Sparse data exist on lymphatics during endocarditis.
  
  
  METHODS
  Fifty-two patients with surgically resected valves were included. Endocarditis was present in 18 aortic and 10 mitral valves. Controls consisted of 15 degenerative aortic and 9 degenerative mitral valves. There were 22 males with endocarditis and 17 males in controls. The mean age was 58 (SD 15) years with endocarditis vs. 62 (SD 13) years for controls. Lymphatics were detected by podoplanin antibody immunohistochemistry and morphometrical analysis was performed.
  
  
  RESULTS
  The lymphatic density in endocarditis was 833 (SD 529) vessels/mm(2) (range 0-1707) as compared with 39 (SD 60) vessels/mm(2) (range 0-250) in controls (p=0.000). In endocarditis, the mean lymphatic size was 153 (SD 372) μm(2) ranging from 1 to 2034μm(2), whereas it was 30 (SD 29) μm(2), with maximum 90μm(2) and minimum 2μm(2) in controls (p=0.000).
  
  
  CONCLUSIONS
  IAL is increased in valves with endocarditis as compared with controls. Lymphatics in heart valves may provide a novel means for treatment strategies against endocarditis.
authors.affiliation: Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland; Department of Pathology, School of Medicine, University of Tampere, Tampere, Finland; Department of Anesthesiology, Southern Carelian Central Hospital, Lappeenranta, Finland.
authors.forename: Eetu
authors.initials: E
authors.lastname: Niinimäki
authors.affiliation: Department of Cardiothoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland.
authors.forename: Ari A
authors.initials: AA
authors.lastname: Mennander
authors.affiliation: Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland; Department of Pathology, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Paavonen
authors.affiliation: Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland. Electronic address: ivana.kholova@sll.fimnet.fi.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kholová
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000737:chemistry / Q000473:pathology; D004696:Endocarditis / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D042583:Lymphangiogenesis / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000737:chemistry / Q000473:pathology
keywords: Endocarditis; Heart valves; Human heart; Lymphangiogenesis; Lymphatic vessel