Edwards W D, Peterson K, Edwards J E
Circulation. 1978 Jan;57(1):181-5. doi: 10.1161/01.cir.57.1.181.
From ten patients aged 15 to 40 years with chronic rheumatic valvular disease and histologically proved Aschoff bodies of active rheumatic myocarditis, the valves were evaluated for incidence, distribution and degree of severity of active inflammation. Prior to death, there had been clinical evidence of active rheumatic fever. In each case, active rheumatic valvulitis was present in at least one valve. Of the individual valves studied, 83% were involved by active inflammation of the leaflets or the anulus or both. The aortic valves was involved in 100% of cases, the mitral valve in 86%, the tricuspid valve in 78% and the pulmonary valve in 70%. The mitral and aortic valves were most frequently involved, but the mitral and tricuspid valves were most severely involved when affected. In every case, active rheumatic lesions of the left atrial appendage were present, but these tended to be less widely distributed than the myocardial Aschoff bodies. The high incidence of active valvulitis supports the concept that chronic fibrosing rheumatic valvular disease results from recurrent active inflammation. Such inflammation may occur without clinical suspicion of active rheumatic fever.
从10例年龄在15至40岁之间、患有慢性风湿性瓣膜病且经组织学证实有活动性风湿性心肌炎阿绍夫小体的患者中，对瓣膜的活动性炎症的发生率、分布及严重程度进行评估。在死亡前，有活动性风湿热的临床证据。在每例患者中，至少有一个瓣膜存在活动性风湿性瓣膜炎。在所研究的各个瓣膜中，83%的瓣膜出现小叶或瓣环或两者的活动性炎症。主动脉瓣在100%的病例中受累，二尖瓣在86%的病例中受累，三尖瓣在78%的病例中受累，肺动脉瓣在70%的病例中受累。二尖瓣和主动脉瓣最常受累，但二尖瓣和三尖瓣受累时病变最为严重。在每一病例中，左心耳均有活动性风湿性病变，但这些病变的分布范围往往比心肌阿绍夫小体小。活动性瓣膜炎的高发生率支持了这样一种观点，即慢性纤维性风湿性瓣膜病是反复活动性炎症的结果。这种炎症可能在无活动性风湿热临床怀疑的情况下发生。
