BPVT versus degeneration: Pathology

(Panels A and B) Typical appearance of BPVT at pathology. In this patient, aortic prosthetic mean gradient increased to 51 mmHg 1 year after surgical implantation. The presence of BPVT was not recognized clinically, and patient went directly to surgery. The pathology specimen shows thrombus (arrows) on the downstream aspect of the valve (aortic side; panel A) with sparing of the coaptation edges. The upstream side (ventricular side; panel B) is usually free of thrombus.
(Panels C and D) Typical appearance of bioprosthetic degeneration at pathology (echocardiographic images presented in the dedicated figure). In this patient, aortic prosthetic mean gradient increased to 37 mmHg 4 years after surgical implantation. Pathology confirmed the TEE findings, with 2 thickened, fused cusps (yellow arrows) and fibro-calcific deposits in the cusp body (dashed red arrow) (aortic side; panel C). Viewed from the ventricular side (panel D), 2 of the cusps are fused in the closed position.