Objective    To analyze pathologic features of left ventricular myocardium in rheumatic heart disease patients with predominate aortic valve stenosis

and observe their left ventricular function recovery after aortic plus mitral valve replacement.     Methods    Thirty-two rheumatic heart disease patients with predominate aortic valve stenosis underwent aortic plus mitral valve replacement. Echocardiography was used to evaluate the left ventricular function before operation

3 months

6 months and 12 months after operation. Left ventricular end-diastolic diameter (LVEDD)

ejection fraction (EF)

fractional shortening (FS) and pressure gradient (PG) of aortic valve

interventricular septal thickness (IVST)

left ventricular posterior wall thickness (LVPWT)

left ventricular mass index (LVMI) were observed. Meanwhile

mitral papillary muscle samples were obtained during operation. Histological features were studied by using Massion staining

and collagenous contents were quantitated with a computer-assisted imaging analysis system

comparing with control samples obtained from 4 accidently died adults.     Results    All 32 patients were discharged without death or complications. There was no death during 10 to 20 months follow-up. The echocardiographic follow-up demonstrated that aortic valve PG significantly decreased (P0.01)

LVEDD and LVMI decreased (P0.05)

EF and FS improved (P0.05) after surgery

while no statistic change was found in IVS and LVPW. Pathologic examination revealed significant myocardial hypertrophy in left ventricle

with vesicles in hypertrophied cardiomyocytes. Significant collagen fibroplasia in myocardial interstitium was observed with Masson’s staining. Comparing with the control group

left ventricular myocardial collagen volume fraction (CVF) and perivascular circumferential area (PVCA) increased significantly (P0.05)

(18.11±4.32)% vs (6.31±1.69)% for CVF

and (1.42±0.80)% vs (0.87±0.71)% for PVCA.     Conclusion    Myocardial fibrosis caused by abnormal collagen accumulation was one of the main characteristics of myocardial tissue observed with Masson’s staining. Left ventricular function was improved after aortic plus mitral valve replacement in rheumatic heart disease patients with predominate aortic valve stenosis. Significant myocardial fibrosis may be one of the reasons obstructing left ventricular functional recovery.