Very often, cardiac valves are
received as a collection of fragments, and adequate gross assessment
is difficult or impossible. Should the valve be received intact or in
large enough pieces to be "reconstructed", the specimen should be
photographed, preferably from different aspects.
Generally the gross aspects of the
valve are of greater diagnostic valve than are the histologic
features. Accordingly, the gross description should include, to the
extent possible, the following information:
- Presence or absence of fibrous thickening; the degree (i.e., mild to severe, with measurements of thickness if extreme) and extent (focal, diffuse).
- Presence or absence of calcification; degree and extent.
- Mobility of leaflets.
- Deficiency of leaflets (perforation, retraction, etc.)
- Excess of valvular tissue (hooding, redundancy)
- Condition of commissures (Is fusion present? To what degree?)
- Condition of the chordae tendineae (fused, shortened, elongated, ruptured)
- Presence or absence of vegetations
- Number of cusps (e.g., bicuspid aortic valve)
- Estimate of valvular stenosis or incompetence (if more or less intact)
Representative sections, decalcified as necessary, (usually one cassette) should be taken.
Unfortunately, many valves are received with no useful history (e.g., "mitral valve replacement"). Since such information is often the key to the diagnosis, a well-place phone call---with a diplomatic scolding about the etiquette of medical consultation---is in order.