Blaszyk H, Witkiewicz A J, Edwards W D
Department of Laboratory Medicine and Pathology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA.
Cardiovasc Pathol. 1999 Jul-Aug;8(4):213-6. doi: 10.1016/s1054-8807(99)00009-5.
A 65-year-old man with chronic hypertension developed dyspnea, a cough, and a new diastolic murmur. Two-dimensional echocardiography showed severe aortic regurgitation. No valvular vegetations were identified and blood cultures were negative. Surgical intervention was recommended, but the patient died of an acute intracranial hemorrhage two weeks later. At autopsy, the posterior aortic cusp was flail, due to rupture of the residual cord above two large fenestrations. There was no acute or healed endocarditis. To our knowledge, this is the eighth reported case of aortic valve incompetence due to spontaneous rupture of a fenestrated cusp. Patients ranged in age from 31-67 years (mean, 54), and 4 (50%) were older than 60 years. Seven (88%) of the 8 were men, and 4 (57%) of 7 had chronic hypertension. Analogously, in another four reported cases, aortic insufficiency developed following spontaneous rupture of the fenestrated raphe of an atypical congenitally bicuspid aortic valve. Noninfective and nontraumatic rupture of cord-like aortic valve structures may result in severe acute aortic regurgitation, particularly in men with chronic hypertension.
一名65岁的慢性高血压男性出现呼吸困难、咳嗽和新的舒张期杂音。二维超声心动图显示严重主动脉瓣反流。未发现瓣膜赘生物，血培养阴性。建议进行手术干预，但患者两周后死于急性颅内出血。尸检时，由于两个大的开窗上方残余索带破裂，主动脉后叶瓣呈连枷样。没有急性或愈合性心内膜炎。据我们所知，这是第八例因开窗瓣叶自发破裂导致主动脉瓣关闭不全的报告病例。患者年龄在31 - 67岁之间（平均54岁），4例（50%）年龄超过60岁。8例中有7例（88%）为男性，7例中的4例（57%）患有慢性高血压。类似地，在另外4例报告病例中，非典型先天性二叶式主动脉瓣的开窗瓣缝自发破裂后出现主动脉瓣关闭不全。条索状主动脉瓣结构的非感染性和非创伤性破裂可能导致严重的急性主动脉瓣反流，尤其是在患有慢性高血压的男性中。
