Increased angiogenesis and lymphangiogenesis in rheumatic mitral valves

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) create a global burden in the field of cardiovascular medicine due to significant morbidity and mortality, particularly in low- and middle-income countries and the underprivileged population. Sequential surgical specimens of mitral valves excised from 19 patients with moderate to marked rheumatic mitral stenosis were included in this study and compared to eight sequential surgical myxomatous degenerative valves (control). The study group population had a mean age of 43.8 (± standard deviation (SD) 13.3) years and comprised 10 female and nine male patients. The controls included three female and five male patients with a mean age of 61.5 (± SD 16.1) years. In RHD, the lymphatic vessel size and count per mm² were increased compared to the degenerative valves. Statistical significance was found in the blood and lymphatic vessel size, and lymphatic vessel count. In RHD, the combined blood and lymphatic vessel size increased from 1.45µm² (± SD 2.52) to 4.91 µm² (± SD 6.33). The lymphatic vessel count was 1,123.86 per mm² (± SD 2,154.68) in the RHD and 213.08 per mm² (± SD 390.13) in the myxomatous degenerative valves. Angiogenesis and lymphangiogenesis characterize mitral valves in RHD.