Takami Yoshiyuki, Tajima Kazuyoshi
Department of Cardiovascular Surgery, Kansai Medical University, Takii Hospital, 10-15 Fumizono-cho, Moriguchi, 570-8507, Japan.
Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Heart Vessels. 2016 Feb;31(2):183-8. doi: 10.1007/s00380-014-0585-5. Epub 2014 Sep 25.
Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010. Before AVR, CT scans were performed to identify MAC, whose severity was graded on a scale of 0-4, with grade 0 denoting no MAC and grade 4 indicating severe MAC. Echocardiography was performed before AVR and at follow-up over 2 years after AVR. MAC was identified in 56 patients with grade 1 (30 %), 2 (39 %), 3 (18 %), and 4 (13 %), respectively. Patients with MAC presented older age (72 ± 8 versus 66 ± 11 years), higher rate of dialysis-dependent renal failure (43 versus 4 %), and less frequency of bicuspid aortic valve (9 versus 36 %), when compared to those without MAC. No significant differences were seen in short- and mid-term mortality after AVR between the groups. In patients with MAC, progression of neither mitral regurgitation nor stenosis was observed at follow-up of 53 ± 23 months for 102 survivors, although the transmitral flow velocities were higher than in those without MAC. In conclusion, MAC represented 53 % of the patients undergoing isolated AVR for AVS, usually appeared in dialysis-dependent elder patients with tricuspid AVS. MAC does not affect adversely upon the survival, without progression of mitral valve disease, at least within 2 years after AVR.
尽管主动脉瓣狭窄（AVS）和二尖瓣环钙化（MAC）具有相似的病理生理基础，但关于它们临床相关性的数据有限。我们试图揭示在因AVS接受主动脉瓣置换术（AVR）的患者中MAC的患病率及其临床特征。我们回顾了2004年至2010年连续接受单纯AVR的106例患者。在AVR之前，进行CT扫描以识别MAC，其严重程度按0 - 4级分级，0级表示无MAC，4级表示严重MAC。在AVR之前以及AVR后2年以上的随访期间进行超声心动图检查。分别在56例患者中识别出MAC，其分级为1级（30%）、2级（39%）、3级（18%）和4级（13%）。与无MAC的患者相比，有MAC的患者年龄更大（72±8岁对66±11岁），依赖透析的肾衰竭发生率更高（43%对4%），二叶式主动脉瓣的发生率更低（9%对36%）。两组之间AVR后的短期和中期死亡率无显著差异。在有MAC的患者中，102名幸存者在53±23个月的随访中未观察到二尖瓣反流或狭窄的进展，尽管二尖瓣血流速度高于无MAC的患者。总之，MAC在因AVS接受单纯AVR的患者中占53%，通常出现在依赖透析的老年三尖瓣AVS患者中。MAC至少在AVR后2年内对生存无不良影响，二尖瓣疾病也无进展。
