Kuboki K
Division of Cardiology, Tokyo Metropolitan Geriatric Hospital.
J Cardiol. 2000 Apr;35(4):287-96.
Congenital bicuspid aortic valve was found in 25 patients(18 men, 7 women, mean age 78 years) of 7,000 consecutive autopsy cases over 60 years old(0.36%). Nine cases showed aortic stenosis(Group AS), 7 cases showed aortic stenosis and regurgitation(Group ASR) (4 cases with stenosis dominancy, 3 cases with regurgitation dominancy), 9 cases showed no aortic stenosis or regurgitation(Group Non-ASR) and no cases showed pure aortic regurgitation. The groups were compared clinically and pathologically. Cardiac death was frequently found in Groups AS and ASR. The aortic valve was the thickest in Group AS(6.0 +/- 2.1 mm), and thicker in Group ASR (4.6 +/- 1.8 mm) than in Group Non-ASR(2.3 +/- 1.1 mm). Seventeen cases(68%) had right-left cusps of the aortic bicuspid valve and 8 cases(32%) had anterior-posterior cusps. Raphe was seen in 18 cases(72%) and was more frequent in Groups ASR and Non-ASR than in Group AS. Especially, all cases had raphes in Group Non-ASR. Calcification was severe in Group AS and in cases with stenosis dominancy in Group ASR. However, calcification was limited in cases with regurgitation dominancy in Group ASR. Calcification was limited or not present in Group Non-ASR. In this study, the frequency of the bicuspid aortic valve in the aged, the ratio of stenosis to regurgitation, and the distribution of calcification in the valve were established. The bicuspid aortic valve did not necessarily become stenotic, and there were cases having no stenosis or regurgitation. Especially, it was shown that cases without raphe were prone to have marked calcification and to become stenotic. On the other hand, cases with raphe were not prone to become stenotic.
在60岁以上的7000例连续尸检病例中，发现25例（18例男性，7例女性，平均年龄78岁）患有先天性二叶式主动脉瓣（占0.36%）。9例表现为主动脉狭窄（AS组），7例表现为主动脉狭窄并反流（ASR组）（4例以狭窄为主，3例以反流为主），9例未出现主动脉狭窄或反流（非ASR组），无病例表现为单纯主动脉反流。对这些组进行了临床和病理比较。AS组和ASR组中心脏性死亡较为常见。AS组的主动脉瓣最厚（6.0±2.1毫米），ASR组（4.6±1.8毫米）比非ASR组（2.3±1.1毫米）厚。17例（68%）主动脉二叶瓣为左右瓣叶，8例（32%）为前后瓣叶。18例（72%）可见瓣叶融合，ASR组和非ASR组比AS组更常见。特别是，非ASR组所有病例均有瓣叶融合。AS组以及ASR组中以狭窄为主的病例钙化严重。然而，ASR组中以反流为主的病例钙化局限。非ASR组钙化局限或无钙化。在本研究中，确定了老年人群中二叶式主动脉瓣的发生率、狭窄与反流的比例以及瓣膜钙化的分布情况。二叶式主动脉瓣不一定会发生狭窄，也有无狭窄或反流的病例。特别是，结果显示无瓣叶融合的病例易于出现明显钙化并发生狭窄。另一方面，有瓣叶融合的病例不易发生狭窄。
