Barnhart G R, Ishihara T, Ferrans V J, Jones M, McIntosh C L, Roberts W C
Circulation. 1982 Aug;66(2 Pt 2):I167-71.
The presence of intracuspal hematomas (ICHs) was investigated in 156 valvular bioprostheses, including 57 (all porcine aortic valvular bioprostheses) that had been implanted in patients and 99 (64 porcine aortic valvular bioprostheses, 29 bovine pericardial bioprostheses and six human dura mater bioprostheses) that had been implanted in sheep. ICHs were found in three mitral bioprostheses in patients and in 14 porcine aortic valvular bioprostheses (nine mitral and five tricuspid) in sheep. Hematomas were not found in the dura mater or pericardial bioprostheses. In each patient and in six of the 14 sheep, the hematomas involved more than one cusp and consisted of erythrocyte accumulations in the spongiosa. They extended from the basal region toward the free edge of the cusp and formed a plane of dissection that involved the spaces left in the spongiosa by removal of proteoglycan material during commercial processing. ICHs may become sites of formation of calcific deposits. ICHs result from entry of blood into the space between the sewing ring and the most basilar region of the bioprosthetic tissue. This space extends throughout the circumference of the bioprosthesis and is continuous with the spongiosa, the layer in which the hematoma develops. The blood penetrates this space through the suture line between bioprosthetic tissue and sewing ring on the inflow surface of porcine valvular bioprostheses mounted on atrioventricular-type stents. ICHs were not found in porcine valvular bioprostheses mounted on aortic-type stents, in which the sutures are more protected and more closely spaced, on in bioprostheses constructed of tissues (parietal pericardium and dura mater), which lack a spongiosa.
对156个瓣膜生物假体进行了瓣叶内血肿（ICHs）的研究，其中包括57个（均为猪主动脉瓣生物假体）已植入患者体内的以及99个（64个猪主动脉瓣生物假体、29个牛心包生物假体和6个人硬脑膜生物假体）已植入绵羊体内的。在患者的3个二尖瓣生物假体以及绵羊的14个猪主动脉瓣生物假体（9个二尖瓣和5个三尖瓣）中发现了ICHs。在硬脑膜或心包生物假体中未发现血肿。在每位患者以及14只绵羊中的6只中，血肿累及多个瓣叶，由海绵层内的红细胞聚集组成。它们从基部区域向瓣叶游离缘延伸，并形成一个剥离平面，该平面涉及商业加工过程中去除蛋白聚糖物质后在海绵层中留下的空间。ICHs可能会成为钙化沉积物形成的部位。ICHs是由于血液进入缝合环与生物假体组织最基部区域之间的空间所致。该空间在生物假体的整个圆周上延伸，并与海绵层相连，血肿就在该层中形成。血液通过安装在房室型支架上的猪瓣膜生物假体流入表面的生物假体组织与缝合环之间的缝线穿透该空间。在安装在主动脉型支架上的猪瓣膜生物假体中未发现ICHs，在这种支架中缝线受到更好的保护且间距更近，在由缺乏海绵层的组织（心包壁层和硬脑膜）构建的生物假体中也未发现ICHs。
