Amyloid deposition in an explanted bioprosthetic aortic valve: case report and review of the literature

Cardiovasc Pathol. 2022 Nov-Dec:61:107469. doi: 10.1016/j.carpath.2022.107469. Epub 2022 Aug 28.

Abstract

Herein we present a case of an 80-year-old gentleman who presented with exertional dyspnea status post aortic valve replacement with #23 Trifecta pericardial St. Jude aortic bioprosthetic valve (BV) 12 years prior. He subsequently underwent valve re-replacement due cusp calcification. Histologically, the surgically explanted BV revealed Congophilic deposits with birefringence under cross-polarized light. Extensive work-up identified no systemic source of amyloid in this patient. Liquid chromatography-tandem mass spectrometry-based (LC-MS/MS) proteomics showed the amyloid was composed of human-origin amyloid signature proteins (apolipoprotein A4, apolipoprotein E, serum amyloid P) and human-origin mu heavy chains. Background bovine collagen was also present. Transmission electron microscopy (TEM) showed collections of 7.5-10 nm nonbranching fibrils, consistent with amyloid. Using these techniques, we classified the amyloid as Mu heavy chain, deposition of which is highly unusual in BV. Finally, we provide a review of the literature regarding isolated amyloid deposition in BV.

Keywords: Amyloid; Aortic valve; Bioprosthetic Valve; Liquid Chromatography-tandem mass spectrometry-based proteomics.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Animals
  • Aortic Valve / surgery
  • Apolipoproteins
  • Bioprosthesis*
  • Cattle
  • Chromatography, Liquid
  • Collagen
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Prosthesis Failure
  • Tandem Mass Spectrometry

Substances

  • Collagen
  • Apolipoproteins