Tomaru T, Uchida Y, Mohri N, Mori W, Furuse A, Asano K
Circulation. 1987 Jul;76(1):68-76. doi: 10.1161/01.cir.76.1.68.
In this study we reevaluated whether the sole cause of mitral valve prolapse (MVP) and aortic valve prolapse (AVP) is myxomatous degeneration. Forty-two surgical cases of prolapsed valves with mitral and/or aortic regurgitation were reviewed (AVP in nine, MVP in 27, and combined AVP and MVP [CVP] in six). On microscopic examination, myxomatous degeneration was observed in 20 patients, including six with AVP, 13 with MVP, and one with CVP. In the other 22 patients, including three with AVP, 14 with MVP, and five with CVP, microscopic examination revealed fibrosis with vascularization and scattered infiltration of inflammatory round cells caused by postinflammatory changes with or without chronic inflammation. We coined the term "postinflammatory valve prolapse" (PIVP) to describe these valves. Both postinflammatory and myxomatous degeneration were observed in seven patients with floppy mitral valves attributable to PIVP. Rupture of chordae tendineae was present in six patients with myxomatous mitral valve and three with PIVP. Seven patients with PIVP had a history of rheumatic fever. The results suggest that valvular prolapse is produced not only by myxomatous degeneration but also by postinflammatory changes, including those caused by rheumatic fever.
在本研究中，我们重新评估了二尖瓣脱垂（MVP）和主动脉瓣脱垂（AVP）的唯一病因是否为黏液样变性。回顾了42例伴有二尖瓣和/或主动脉瓣反流的脱垂瓣膜手术病例（9例为AVP，27例为MVP，6例为AVP合并MVP [CVP]）。显微镜检查发现，20例患者存在黏液样变性，其中6例为AVP，13例为MVP，1例为CVP。在其他22例患者中，包括3例AVP、14例MVP和5例CVP，显微镜检查显示为炎症后改变（伴有或不伴有慢性炎症）导致的纤维化伴血管化及炎症性圆形细胞散在浸润。我们创造了“炎症后瓣膜脱垂”（PIVP）一词来描述这些瓣膜。7例因PIVP导致的二尖瓣松弛患者中同时观察到了炎症后改变和黏液样变性。6例黏液样二尖瓣患者和3例PIVP患者存在腱索断裂。7例PIVP患者有风湿热病史。结果表明，瓣膜脱垂不仅由黏液样变性引起，还由炎症后改变引起，包括风湿热所致的改变。
