Moriyama Y, Toyohira H, Koga M, Watanabe S, Saigenji H, Shimokawa S, Taira A
Second Department of Surgery, Kagoshima University, School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jul;43(7):951-5.
From 1989 through 1993 thirty-eight patients underwent aortic valve replacement at our institution for isolated aortic regurgitation (AR) caused by idiopathic degeneration of the valve. There were 32 male and 6 female patients aged between 33 and 74 years with a mean of 59 years. Preoperative New York Heart Association functional class, cardiothoracic ratio, cardiac index, and left ventricular end-diastolic pressure were 2.6, 57%, 3.1 L/min/m2, and 18 mmHg, respectively. Cross-sectional echocardiography clarified aortic valve prolapse in seven patients. Excised valvular cusps were thin, redundant and translucent in association with cuspal fenestration in 9 cases and idiopathic commissural disruption in 2 cases. Histological study revealed significant disruption of the fibrosa and cystic degeneration of the spongiosa layer filled with mucopolysaccharide. Actuarial survival rate, including 3 operative deaths, was 89% at 3 years after AVR with no apparent valve related complications. Idiopathic degeneration of the aortic valve is a common cause of AR, occurring in half of the surgically treated patients. We emphasize the importance of this lesion as a cause of AR.
从1989年至1993年，我院有38例患者因瓣膜特发性退变导致单纯主动脉瓣反流（AR）而接受了主动脉瓣置换术。患者共32例男性和6例女性，年龄在33至74岁之间，平均年龄59岁。术前纽约心脏协会心功能分级、心胸比率、心脏指数和左心室舒张末期压力分别为2.6、57%、3.1L/min/m²和18mmHg。经胸超声心动图检查发现7例患者存在主动脉瓣脱垂。切除的瓣膜叶薄、冗长且呈半透明状，9例伴有瓣叶穿孔，2例伴有特发性瓣叶连合部破裂。组织学研究显示纤维层有明显破坏，海绵层充满粘多糖并发生囊性变。包括3例手术死亡患者在内，主动脉瓣置换术后3年的精算生存率为89%，无明显的瓣膜相关并发症。主动脉瓣特发性退变是AR的常见原因，在接受手术治疗的患者中占一半。我们强调该病变作为AR病因的重要性。
