Robicsek Francis, Thubrikar Mano J, Cook Joseph W, Fowler Brett
Carolinas Heart Institute at Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Ann Thorac Surg. 2004 Jan;77(1):177-85. doi: 10.1016/s0003-4975(03)01249-9.
The study was intended to investigate the reason why congenitally bicuspid valves (CBAVs), which may function hemodynamically and clinically well, have a high early failure rate.
Observations were made on cryopreserved, then thawed human aortic roots containing CBAVs. Valvular function was studied in the left heart simulator using conventional and 500-frames/second cinematography, intravascular ultrasound, by preparation of silicone molds, and by computerized digital modeling.
The function of the clinically "normal" CBAVs is characterized by (a). excessive folding and creasing, which (unlike in the trileaflet valve) persist throughout the cardiac cycle; (b). extended areas of leaflet contact; (c). significant morphologic stenosis; and (d). asymmetrical flow patterns and turbulence.
The above features subject the CBAV to abnormally high stresses and may lead to early thickening and eventually calcification and stenosis. The abnormal flow patterns also predilect for dilatation and dissection of the ascending aorta.
本研究旨在探究先天性二叶式主动脉瓣（CBAV）血流动力学和临床功能良好，但早期故障率却很高的原因。
对含有CBAV的经冷冻保存后解冻的人主动脉根部进行观察。通过传统的每秒500帧的电影摄影、血管内超声、制作硅胶模型以及计算机数字建模，在左心模拟器中研究瓣膜功能。
临床上“正常”的CBAV功能具有以下特征：（a）过度折叠和起皱，（与三叶瓣不同）在整个心动周期中持续存在；（b）瓣叶接触面积扩大；（c）明显的形态学狭窄；（d）不对称的血流模式和湍流。
上述特征使CBAV承受异常高的应力，并可能导致早期增厚，最终钙化和狭窄。异常的血流模式也易引发升主动脉扩张和夹层形成。
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