Amyloid deposition in an explanted bioprosthetic aortic valve: case report and review of the literature

Jonika M. Weerasekare, Fang Zhou, Adam H. Skolnick, Hasan Jilaihawi, Mathew R. Williams, Surendra Dasari, Ellen D. McPhail, Jason D. Theis, Linda N. Dao, John P. Bois, Joseph J. Maleszewski, Melanie C. Bois

Research output: Contribution to journalArticlepeer-review


Herein we present a case of an 80-year-old gentleman who presented with exertional dyspnea status post aortic valve replacement with #23 Trifecta pericardial St. Jude aortic bioprosthetic valve (BV) 12 years prior. He subsequently underwent valve re-replacement due cusp calcification. Histologically, the surgically explanted BV revealed Congophilic deposits with birefringence under cross-polarized light. Extensive work-up identified no systemic source of amyloid in this patient. Liquid chromatography-tandem mass spectrometry-based (LC-MS/MS) proteomics showed the amyloid was composed of human-origin amyloid signature proteins (apolipoprotein A4, apolipoprotein E, serum amyloid P) and human-origin mu heavy chains. Background bovine collagen was also present. Transmission electron microscopy (TEM) showed collections of 7.5-10 nm nonbranching fibrils, consistent with amyloid. Using these techniques, we classified the amyloid as Mu heavy chain, deposition of which is highly unusual in BV. Finally, we provide a review of the literature regarding isolated amyloid deposition in BV.

Original languageEnglish (US)
Article number107469
JournalCardiovascular Pathology
StatePublished - Nov 1 2022


  • Amyloid
  • Aortic valve
  • Bioprosthetic Valve
  • Liquid Chromatography-tandem mass spectrometry-based proteomics

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Cardiology and Cardiovascular Medicine


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