Olson L J, Subramanian R, Edwards W D
Mayo Clin Proc. 1984 Dec;59(12):835-41. doi: 10.1016/s0025-6196(12)65618-3.
The gross surgical pathologic features of the aortic valve were reviewed in 225 patients who had had clinically pure aortic insufficiency and aortic valve replacement at our institution during the years 1965, 1970, 1975, and 1980. The four most common causes of aortic regurgitation were postinflammatory disease (46%), aortic root dilatation (21%), incomplete closure of a congenitally bicuspid aortic valve (20%), and infective endocarditis (9%). Other causes of aortic incompetence in our study included ventricular septal defects (2%) and quadricuspid aortic valves (1%); the cause was indeterminate in 1%. The mean age of patients at valve replacement was approximately 50 years for all etiologic factors except a ventricular septal defect. All forms of aortic insufficiency were much more common in male than in female patients, except the postinflammatory and indeterminate types, which occurred approximately equally in both sexes. Moreover, the incidences of postinflammatory disease and aortic root dilatation changed appreciably with time. Before 1980, their incidences were 51% and 17%, respectively, but during 1980, they were 29% and 37%, respectively. Accordingly, aortic root dilatation is now the most common cause of pure aortic regurgitation in our surgical population. The decrease in the incidence of postinflammatory disease may be a result of the decreasing incidence of acute rheumatic fever reported in western countries.
回顾了1965年、1970年、1975年和1980年期间在我院接受临床单纯主动脉瓣关闭不全并主动脉瓣置换术的225例患者的主动脉瓣大体手术病理特征。主动脉瓣反流的四个最常见原因是炎症后疾病（46%）、主动脉根部扩张（21%）、先天性二叶主动脉瓣关闭不全（20%）和感染性心内膜炎（9%）。本研究中主动脉瓣关闭不全的其他原因包括室间隔缺损（2%）和四叶主动脉瓣（1%）；1%的病因不明。除室间隔缺损外，所有病因导致的患者瓣膜置换时的平均年龄约为50岁。除炎症后和病因不明类型在男女中发生率大致相同外，所有形式的主动脉瓣关闭不全在男性中比在女性中更为常见。此外，炎症后疾病和主动脉根部扩张的发生率随时间有明显变化。1980年前，它们的发生率分别为51%和17%，但在1980年期间，分别为29%和37%。因此，主动脉根部扩张现在是我们手术人群中单纯主动脉瓣反流的最常见原因。炎症后疾病发生率的下降可能是西方国家急性风湿热发病率下降的结果。
