Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.
Am J Cardiol. 2013 Aug 15;112(4):541-53. doi: 10.1016/j.amjcard.2013.04.020. Epub 2013 May 29.
Although a number of publications have described the natural history of patients with aortic stenosis (AS), the definition of "natural history" varies widely. Those describing a large number of patients with AS without operative therapy with necropsy findings are rare. Two hundred sixty patients >15 years of age with AS were studied at necropsy over a 50-year period by the same investigator. Of the 260 patients, the valve in 37 (14%) was congenitally unicuspid, in 123 (47%), congenitally bicuspid, and in 100 (38%), tricuspid. Aortic valve structure varied with age of death (in years; unicuspid 52 ± 17, bicuspid 63 ± 12, and tricuspid 70 ± 14 years); gender (men/women: unicuspid 95%/5%, bicuspid 78%/22%, and tricuspid 63%/37%), and frequency of calcium in the mitral valve annulus and epicardial coronary arteries. The patients with cardiac-related symptoms compared with those without were more likely to have a congenitally malformed valve (unicuspid 17% vs 12%; bicuspid 51% vs 29%; tricuspid 31% vs 60%; unadjusted p = 0.013), to die from cardiac disease (86% vs 54%; unadjusted p = 0.001), and to have larger hearts (mean cardiac weight 606 ± 138 g vs 523 ± 121 g; unadjusted p = 0.009) and a larger quantity of calcium in the aortic valve cusps. In conclusion, the length of survival in adults with AS is related to valve structure, gender, presence of cardiac-related symptoms, cardiac mass, and quantity of calcium in the aortic valve cusps.
尽管已有许多出版物描述了主动脉瓣狭窄（AS）患者的自然病史，但“自然病史”的定义差异很大。很少有描述大量未经手术治疗且尸检发现的 AS 患者的报道。在 50 年的时间里，同一位研究者对 260 名年龄大于 15 岁的 AS 患者进行了尸检研究。在 260 名患者中，37 名（14%）的主动脉瓣为先天性单瓣，123 名（47%）为先天性二瓣，100 名（38%）为三瓣。主动脉瓣结构随死亡年龄（年；单瓣 52±17 岁，二瓣 63±12 岁，三瓣 70±14 岁）、性别（男女：单瓣 95%/5%，二瓣 78%/22%，三瓣 63%/37%）和二尖瓣环及心外膜冠状动脉的钙含量而变化。与无症状患者相比，有心脏相关症状的患者更有可能存在先天性畸形瓣膜（单瓣 17%比 12%；二瓣 51%比 29%；三瓣 31%比 60%；未调整的 p=0.013），死于心脏疾病（86%比 54%；未调整的 p=0.001），且心脏更大（平均心脏重量 606±138 g 比 523±121 g；未调整的 p=0.009），主动脉瓣瓣叶的钙含量也更多。总之，AS 成人的生存时间与瓣叶结构、性别、心脏相关症状、心脏质量和主动脉瓣瓣叶钙含量有关。
