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Citric acid as a decalcifying agent for the excised calcified human heart valves [Anatol J Cardiol]
Anatol J Cardiol. 2008; 8(2): 94-98

Citric acid as a decalcifying agent for the excised calcified human heart valves

Necmi Köse1, Barlas Naim Aytaçoğlu1, Necat Yılmaz2, H. Ali Döndaş2, Lülüfer Tamer3, Banu Coşkun2, Özden Vezir1, Nehir Sucu1, Murat Dikmengil1
1Department of Cardiovascular Surgery Faculty of Medicine Mersin University, Mersin, Turkey
2Department of Histology and Embriology Faculty of Medicine Mersin University, Mersin, Turkey
3Department of Biochemistry Faculty of Medicine Mersin University, Mersin, Turkey

Objective: Cardiac valvular pathologies are frequently encountered as mechanical and functional disorders due to the calcification of the valves whatever the etiologies are. This pathophysiologic table usually ends up with valvular replacement. In this study we aimed to decrease/eliminate the calcium in the excised calcified human heart valves by using citric acid in vitro hence bringing about the question for possible oral treatment of calcification of the valves by citric acid ingestion. Methods: Fourteen pieces of mitral and/or aortic valves excised from 12 patients undergoing valve replacement were placed in a freshly prepared phosphate buffered saline solution containing 0.625% glutaraldehyde at +4 0C for 48 h. They were rinsed with 0.9% NaCl and divided into two groups; study and control. Control tissues were further treated in a freshly prepared solution with identical properties for another 5 days. Study tissues were placed into a solution containing 3.8% citric acid (pH 7.4) and kept for 48 h at +37 0C, then rinsed with 0.9% NaCl and transferred into a fresh solution containing 0.625% glutaraldehyde with phosphate buffer at 37 0C for 3 more days. Specimens were biochemically and histopathologically evaluated and compared using Mann Whitney U test. Results: Calcium and phosphate levels in the study group were lower than in the control group (852.5±913.41 µg g-1 vs 413.05±519.53 µg g-1, p=0.001 and 207.6±321.86 µg g-1 vs 124.4±289.48 µg g-1, p=0.035, respectively). Malondialdehyde and protein level values were changed insignificantly in the control and study groups. Histopathologic evaluation showed that collagen and elastin fibers were similar in both groups. In the study group, irregular and fusiform calcific formations around the collagen fibers were significantly decreased. Conclusions: Decalcifying human heart valves in vitro conditions with citric acid without an adverse change to the morphology of the valvular tissue specimens is meaningful. We believe that forwarding and looking for the answer to the question “whether systemic application of citric acid could lead to the decalcification and/or reduction of calcification in the native human heart valves” would be expressive.

Keywords: Decalcification, citric acid, human heart valves


Necmi Köse, Barlas Naim Aytaçoğlu, Necat Yılmaz, H. Ali Döndaş, Lülüfer Tamer, Banu Coşkun, Özden Vezir, Nehir Sucu, Murat Dikmengil. Citric acid as a decalcifying agent for the excised calcified human heart valves. Anatol J Cardiol. 2008; 8(2): 94-98


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