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Can Degenerative Aortic Valve Stenosis Be Related to Persistent Chlamydia pneumoniae Infection?

Jukka Juvonen, MD; Tatu Juvonen, MD; Aino Laurila, MD; Johanna Kuusisto, MD; Eeva Alarakkola, MD; Terttu Sarkioja, MD; Carol A. Bodian, DrPH; Matti I. Kairaluoma, MD; and Pekka Saikku, MD
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From National Public Health Institute, Oulu University Hospital, and University of Oulu, Oulu, Finland; Kuopio University Hospital and University of Kuopio, Kuopio, Finland; and Mount Sinai School of Medicine, New York, New York. Grant Support: By the Sigrid Juselius Foundation, Finland. Acknowledgments: The authors thank Fran Williams, BA, for technical help during the preparation of the manuscript. Requests for Reprints: Tatu Juvonen, MD, PhD, Department of Surgery, Oulu University Hospital, FIN-90220 Oulu, Finland. Current Author Addresses: Dr. J. Juvonen: Department of Internal Medicine, Kainuu Central Hospital, FIN-87140 Kajaani, Finland.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(9):741-744. doi:10.7326/0003-4819-128-9-199805010-00007
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Background: The cause of age-related degenerative (tricuspid) aortic valve calcification is largely unknown, but one typical characteristic is an active inflammatory process. The presence of Chlamydia pneumoniae in aortic valve stenosis was recently shown.

Objective: To test the hypothesis that if persistent C. pneumoniae infection plays an active role in the development of aortic stenosis, the organism can be detected in the healthy aortic valves of young persons.

Design: A cadaver study.

Setting: Oulu University Hospital, Oulu, Finland.

Subjects: 46 consecutive cadavers undergoing autopsy.

Measurements: Macroscopic and histologic pathology of aortic valves was determined The presence of C. pneumoniae was determined by immunohistochemistry.

Results: 34 of 46 valves were macroscopically normal. Early lesions of aortic valve disease were found in 12 valves (no lesions in valves from persons 20 to 40 years of age [n = 15], 4 lesions in valves from persons 41 to 60 years of age [n = 16], and 8 lesions in valves from persons older than 60 years of age [n = 15]; P = 0.004). Fifteen of 34 normal valves (44%) and 10 of 12 valves with early lesions (83%) had positive results on staining for C. pneumoniae (P = 0.02). In persons older than 60 years of age, the chance of an early lesion was higher if the valve tested positive for C. pneumoniae (7 of 8 valves with C. pneumoniae infection compared with 1 of 7 valves without C. pneumoniae infection; P = 0.01).

Conclusions: Chlamydia pneumoniae is frequently present in aortic valves and is associated with early lesions of aortic valve stenosis in elderly persons.


Grahic Jump Location
Figure 1.
A positive result on immunohistochemical staining with Chlamydia pneumoniae species specific antibody in mononuclear cells (arrows) of a macroscopically normal aortic valve.

Original magnification, x200.

Grahic Jump Location




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