Osterberger L E, Goldstein S, Khaja F, Lakier J B
Circulation. 1981 Sep;64(3):472-6. doi: 10.1161/01.cir.64.3.472.
Mitral insufficiency with mitral annular calcification occurring predominantly in elderly females has been described. We studied six patients with mitral diastolic obstruction associated with mitral annular calcification without stenosis of the mitral leaflets. Three were males and three were females, aged 43-77 years. All had significant diastolic gradients across the mitral valve (mean gradient 16 mm Hg) recorded at catheterization. Two patients had aortic and three had mitral valve replacement. No patient had retraction of the mitral leaflets, diffuse thickening or fusion of the commissures at surgery or pathologic examination. Three patients had severe mitral insufficiency, one associated with voluminous prolapsing mitral leaflets and one as a result of ruptured chordae tendineae. The left ventricle was dilated in three patients, two with mitral regurgitation and one with mixed aortic valve disease. Active mitral annular motion is a normal event and is necessary for normal valvular function; severe calcification of the ring interferes with its normal diastolic relaxation and this alone may explain the holodiastolic mitral gradient found in these patients.
二尖瓣关闭不全合并二尖瓣环钙化主要见于老年女性，已有相关报道。我们研究了6例伴有二尖瓣环钙化且无二尖瓣叶狭窄的二尖瓣舒张期梗阻患者。其中3例为男性，3例为女性，年龄在43 - 77岁之间。所有患者在导管检查时均记录到二尖瓣跨瓣显著的舒张期压差（平均压差16 mmHg）。2例患者进行了主动脉瓣置换，3例进行了二尖瓣置换。在手术或病理检查中，没有患者出现二尖瓣叶回缩、瓣叶弥漫性增厚或瓣叶交界融合的情况。3例患者存在严重二尖瓣关闭不全，1例与大量二尖瓣叶脱垂有关，1例是由于腱索断裂所致。3例患者左心室扩大，2例伴有二尖瓣反流，1例伴有混合性主动脉瓣疾病。二尖瓣环的主动运动是正常现象，对正常瓣膜功能至关重要；瓣环的严重钙化会干扰其正常的舒张期松弛，仅此一点就可能解释这些患者出现的全舒张期二尖瓣压差。
