MYXOMATOUS MITRAL-VALVES - COLLAGEN DISSOLUTION AS THE PRIMARY DEFECT
MYXOMATOUS MITRAL-VALVES - COLLAGEN DISSOLUTION AS THE PRIMARY DEFECT
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DOI：
10.1161/01.cir.66.2.288
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发表时间：
1982-01-01
期刊：
影响因子：
37.8
通讯作者：
WOOLEY, CF
中科院分区：
文献类型：
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作者：
KING, BD;CLARK, MA;WOOLEY, CF
对12例二尖瓣返流患者二尖瓣脱垂（粘液瘤性）的形态学和组织学特征进行了研究，并与13例对照瓣膜进行了比较。粘液瘤二尖瓣（MMV）的平均表面积为1990 mm 2，对照二尖瓣（CMV）的平均表面积为760 mm 2（P < 0.001）。MMV的平均最长径为56.4mm，CMV的平均最长径为36.8mm（P < 0.001）。MMV平均最短径为44.8mm，CMV平均最短径为22.7mm（P < 0.001）。MMV的平均连合直径为50.4mm，CMV为30.0mm（P < 0.001）。MMV的平均接合线距离为34.1mm，CMV为22.5mm（P < 0.001）。MMV前瓣平均表面积为910 mm ~ 2，CMV为560 mm ~ 2（P < 0.01）。后叶平均表面积MMV为927 mm 2，CMV为534 mm 2（P < 0.02）。CMV的平均密度为1.07，MMV的平均密度为0.687 g/cm ~ 3（P < 0.01）。g.cm弹性蛋白的溶解在MMV中仅比在CMV中稍微更频繁。1/2 CMV可见粘液瘤样变，MMV仅在腱索和纤维部可见粘液瘤样变（P < 0.05）。MMV除瓣环外，其他部位粘多糖浸润均较CMV严重（P < 0.05）。所有MMV的纤维部和腱索胶原断裂均较严重，而CMV的纤维部和腱索胶原断裂均较严重（P < 0.05）。大体形态学（表面积增加、直径增加和密度降低）和组织学特征（胶原溶解伴粘液瘤变性）允许CMV和MMV之间明确分离，导致重度二尖瓣返流。纤维部和腱索中的胶原溶解仅存在于MMV中，这表明重度二尖瓣返流并发二尖瓣脱垂综合征患者的二尖瓣中的胶原溶解是首要的。显然，该过程是胶原蛋白合成、含量或组织的紊乱（即，一种发育不良的胎生症）。
The morphologic and histologic characteristics of redundant prolapsing (myxomatous) mitral valves from 12 symptomatic patients with severe mitral regurgitation who required mitral valve replacement were studied and compared with those in 13 control valves. The mean surface area of the myxomatous mitral valves (MMV) was 1990 mm and of the control mitral valves (CMV) 760 mm2 (P < 0.001). The mean longest diameter of MMV was 56.4 mm and of the CMV 36.8 mm (P < 0.001). The mean shortest diameter of MMV was 44.8 mm and of CMV 22.7 mm (P < 0.001). The mean commissural diameter for MMV was 50.4 mm and for CMV 30.0 mm (P < 0.001). The mean coapting line distance of MMV was 34.1 mm and of CMV 22.5 mm (P < 0.001). The mean surface area of the anterior cusp of MMV was 910 mm2 and of CMV 560 mm2 (P < 0.01). The mean surface area of posterior leaflet was 927 mm2 in MMV and 534 mm2 in CMV (P < 0.02). CMV densities were nearly uniform (1.07 g.cm), while the mean density of MMV was 0.687 g/cm3 (P < 0.01). Dissolution of elastin was only slightly more frequent in MMV than in CMV. Myxomatous degeneration, noted in 1/2 of CMV, was found in chordae and pars fibrosa only in MMV (P < 0.05). Mucopolysaccharide infiltration was more severe in all sites except the annulus in MMV than in CMV (P < 0.05). Fragmentation of collagen was severe in either the pars fibrosa or chorda of all MMV but was not seen in any CMV in these areas (P < 0.05). Gross morphology (increased surface area, increased diameter and decreased density) and histologic characteristics (collagen dissolution with myxomatous degeneration) allowed clear separation between CMV and MMV that produced severe mitral regurgitation. Collagen dissolution in the pars fibrosa and chordae was present only in MMV, which suggests the primacy of collagen dissolution in mitral valves of patients with severe mitral regurgitation complicating the mitral valve prolapse syndrome. Apparently, this process is a disorder of collagen synthesis, content or organization (i.e., a dyscollagenosis).