Deforming fibrotic valvular disease

Deforming fibrotic valvular disease, esp mitral stenosis, due to RHD
Results from host immune response to group A streptococcal antigens
Antibodies and CD4+ T cells against streptococcal M proteins can recognize cardiac self antigens
Antibody binding can activate complement and recruit Fc-receptor bearing cells
Macrophage activation occurs by cytokine production due to stimulated T cells
Heart tissue damage occurs by antibody and T cell mediated reaction
Acute RF: Focal inflammatory lesions in tissues
Ashchoff bodies seen in heart
Anitschkow cells pathognomic of RF, are seen in heart
Pancarditis
Verrucae seen along line of closure
Subendocardial lesions may induce MacCallum plaques in left atrium
Fish mouth/button hole stenoses
Leaflet thickening
Thickening and fusion of tendinous cords
Commissural fusion and shortening