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CLINICAL RESEARCH: VALVULAR HEART DISEASE

In Vivo Aortic Valve Thermal Heterogeneity in Patients With Nonrheumatic Aortic Valve Stenosis

The First In Vivo Experience in Humans

Konstantinos Toutouzas, MD^_*,_*, Maria Drakopoulou, MD^_*, Andreas Synetos, MD^_*, Eleftherios Tsiamis, MD^_*, George Agrogiannis, MD, Nikolaos Kavantzas, MD, Eustratios Patsouris, MD, Dimitris Iliopoulos, MD, Stergios Theodoropoulos, MD, Magdi Yacoub, MD^,|| and Christodoulos Stefanadis, MD^_*

^_* First Department of Cardiology, Hippokration Hospital, Athens, Greece
Department of Pathology, Athens Medical School, Athens, Greece
Department of Cardiosurgery, Iatriko Kentro, Marousi, Athens, Greece
Department of Cardiosurgery, Iasso General Hospital, Athens, Greece
^|| Imperial College Heart Science Center, Harefield Hospital, London, United Kingdom.

Manuscript received January 30, 2008; revised manuscript received March 19, 2008, accepted April 5, 2008.

^_* Reprint requests and correspondence: Dr. Konstantinos Toutouzas, 26 Karaoli and Dimitriou Street, Holargos, 15562 Athens, Greece. (Email: ktoutouz{at}otenet.gr).

Objectives: We investigated in vivo in aortic valve stenosis (AVS) whether there is: 1) thermal heterogeneity within the valve leaflets; 2) temperature difference between the leaflets and the ascending aortic wall; and 3) a possible correlation between heat production, inflammation, and neoangiogenesis.

Background: Histological studies have demonstrated a potential role of inflammation and neoangiogenesis in AVS.

Methods: We examined 96 leaflets scheduled for aortic valve replacement. Twenty-five patients had AVS, and 7 had aortic valve insufficiency (AVI). Temperature measurements were performed right before hypothermic cardioplegia. Temperature difference (T) was assigned as the mean temperature of each leaflet minus the temperature of the aortic wall. Histological, immunohistological analysis, and vascular endothelial growth factor (VEGF) immunoreactivity was performed.

Results: Significant thermal heterogeneity was recorded within the leaflets of AVS, compared with AVI (1.52 ± 1.35°C vs. 0.13 ± 0.11°C, p < 0.01). In AVS T was greater in all leaflets compared with the AVI group (p < 0.01). Leaflets of AVS had increased inflammatory cell infiltration, calcium deposit, and anti-VEGF expression compared with AVI (p < 0.01).

Conclusions: Thermal heterogeneity is increased in AVS and correlates with inflammatory mononuclear cell infiltration, expression of pro-inflammatory cytokines and neoangiogenic factors.

Key Words: aortic valve • inflammation thermography

Abbreviations and Acronyms   AVI = aortic valve insufficiency   AVS = aortic valve stenosis   CD3 = cluster of differentiation 3   IL = interleukin   TNF = tumor necrosis factor   VEGF = vascular endothelial growth factor   T = temperature difference

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