In valvular disease, assessment of the gross appearance often contributes to the final diagnosis more than microscopic examination.
Mitral valve stenosis: most commonly due to rheumatic fever with commissural fusion, cusp scarring and dystrophic calcification.
Mitral valve regurgitation: due to floppy mitral valve, shows valve cusps which are increased in area, dome shaped and show myxoid change. Other causes include rheumatic fever, rupture of a papillary muscle or chordae tendinae, ventricular enlargement or infective endocarditis.
Aortic valve stenosis: due to calcification of a congenitally bicuspid valve, senile calcific aortic stenosis or post-inflammatory scarring.
Aortic regurgitation: secondary to post-inflammatory scarring, infective endocarditis or abnormalities of the cusps and commissures.
Pulmonary valve abnormalities: consist of stenosis, insufficiency or a combination of the two. Ninety-five per cent of cases are due to congenital heart disease, tetralogy of Fallot being the most common. A bicuspid pulmonary valve is the most common anomaly.
Tricuspid valve abnormalities: most commonly pure insufficiency and caused by postinflammatory scarring, congenital abnormalities, infective endocarditis or dilatation of the valve ring in cardiac failure.
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