Sawada H, Shionoya M, Shibata Y, Aoki K, Furuta S, Kato K
Cardiovascular Institute, Tokyo.
J Cardiol. 1996 Oct;28(4):221-6.
The pathogenesis of nonrheumatic calcification of the mitral valve was investigated by analyzing the clinical and echocardiographic characteristics of patients with mitral valvular calcification without any findings suggestive of rheumatic heart disease or infective endocarditis. Calcification of the mitral valve was observed in nine patients, who all had calcified stenotic (aortic valve area < 1 cm2) bicuspid aortic valve. Calcification of the mitral valve was localized to the basal portion of ventricular aspect of the anterior mitral leaflet and contiguous to that of the aortic valve. Mobility and thickness of the mitral leaflet was normal except for the calcified portion. Calcification of the mitral valve was not contiguous to posterior mitral annular calcification nor was related to direction of aortic regurgitant flow. In patients with calcified stenotic bicuspid aortic valve, calcification of the mitral valve was not associated with location of the two aortic cusps, aortic valve area, aortic valvular peak pressure gradient, direction of the left ventricular outflow, end-diastolic left ventricular outflow tract dimension, end-diastolic dimension of the aortic annulus, incidence of aortic regurgitation, calcification of the aortic arch, or risk factors of atherosclerosis. Six patients with mitral valvular calcification had aortic valve replacement. Preoperative coronary angiogram of these patients was normal. Calcification of the aortic valve was on the ventricular and aortic aspects. The calcification of the aortic valve, anterior mitral ring, or anterior mitral leaflet was not rheumatic in these six patients. Rheumatic disease, risk factors of atherosclerosis, mechanical stress by left ventricular outflow or aortic regurgitant flow, or mitral annular calcification did not appear to be related to mitral valvular calcification. The distribution of aortic and mitral valvular calcification suggested that the calcification of the mitral valve was due to progression of calcification of the bicuspid aortic valve.
通过分析无风湿性心脏病或感染性心内膜炎迹象的二尖瓣钙化患者的临床和超声心动图特征，对二尖瓣非风湿性钙化的发病机制进行了研究。观察到9例患者有二尖瓣钙化，他们均患有钙化性狭窄（主动脉瓣面积<1 cm²）的二叶式主动脉瓣。二尖瓣钙化局限于二尖瓣前叶心室面的基部，与主动脉瓣相邻。除钙化部分外，二尖瓣叶的活动度和厚度正常。二尖瓣钙化与二尖瓣后环钙化不相邻，也与主动脉反流方向无关。在患有钙化性狭窄二叶式主动脉瓣的患者中，二尖瓣钙化与两个主动脉瓣叶的位置、主动脉瓣面积、主动脉瓣峰值压力梯度、左心室流出道方向、舒张末期左心室流出道内径、主动脉瓣环舒张末期内径、主动脉反流发生率、主动脉弓钙化或动脉粥样硬化危险因素无关。6例二尖瓣钙化患者接受了主动脉瓣置换术。这些患者术前冠状动脉造影正常。主动脉瓣钙化位于心室面和主动脉面。这6例患者的主动脉瓣、二尖瓣前环或二尖瓣前叶钙化并非风湿性。风湿性疾病、动脉粥样硬化危险因素、左心室流出道或主动脉反流的机械应力或二尖瓣环钙化似乎与二尖瓣钙化无关。主动脉瓣和二尖瓣钙化的分布表明，二尖瓣钙化是由于二叶式主动脉瓣钙化进展所致。
