A classification system for the bicuspid aortic valve from 304 surgical specimens
A classification system for the bicuspid aortic valve from 304 surgical specimens
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DOI：
10.1016/j.jtcvs.2007.01.039
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发表时间：
2007-05-01
影响因子：
6
通讯作者：
Schmidtke, Claudia
中科院分区：
文献类型：
--
作者：
Sievers, Hans-H.;Schmidtke, Claudia
目的：一般来说，疾病的分类已被证明有利于疾病的管理。这可能也适用于二尖瓣，因为术语“二尖瓣”代表一种常见的先天性主动脉瓣畸形，具有不同的表型和功能，导致不同的治疗策略。我们试图建立一个基于5年的手术标本数据收集的分类系统。方法：1999-2003年间，从304例二尖瓣病变的主动脉瓣手术报告中获得对瓣膜病理的精确描述。对二尖瓣的几种不同特征进行了测试，建立了简明、易用的二尖瓣分类系统。结果：系统分类的三个特征：(1)瓣叶数目，(2)瓣叶或瓣叶的空间位置，(3)瓣膜的功能状态。第一个特征被发现是最重要的，因此被称为“类型”。主要有三种类型：类型0(无中缝)、类型1(一个中缝)和类型2(两个中缝)，其次是空间位置和功能两个补充特征。这些特征有助于将二尖瓣主动脉瓣分为三类。最常见的是带有一个中缝的二尖瓣主动脉瓣(1型，n=269)。该中缝位于左(L)和右(R)冠状静脉窦之间216例(1型，L/R)，血流动力学占优势的狭窄(S)119例(1型，L/R，S)。只有21例患者的二尖瓣没有中缝(0型)。结论：提出了一种二尖瓣的分类系统，包括一个主要类别(“类型”)和两个补充类别。这种分类，即使单独用于主要类别(类型)，可能有利于更好地定义二尖瓣主动脉瓣疾病，促进科学交流，并改进治疗。
Objective: In general, classification of a disease has proven to be advantageous for disease management. This may also be valid for the bicuspid aortic valve, because the term "bicuspid aortic valve" stands for a common congenital aortic valve malformation with heterogeneous morphologic phenotypes and function resulting in different treatment strategies. We attempted to establish a classification system based on a 5-year data collection of surgical specimens.Methods: Between 1999 and 2003 a precise description of valve pathology was obtained from operative reports of 304 patients with a diseased bicuspid aortic valve. Several different characteristics of bicuspid aortic valves were tested to generate a pithy and easily applicable classification system.Results: Three characteristics for a systematic classification were found appropriate:(1) number of raphes,(2) spatial position of cusps or raphes, and(3) functional status of the valve. The first characteristic was found to be the most significant and therefore termed "type." Three major types were identified: type 0 (no raphe), type 1 (one raphe), and type 2 (two raphes), followed by two supplementary characteristics, spatial position and function. These characteristics served to classify and codify the bicuspid aortic valves into three categories. Most frequently, a bicuspid aortic valve with one raphe was identified (type 1, n = 269). This raphe was positioned between the left (L) and right (R) coronary sinuses in 216 (type 1, L/R) with a hemodynamic predominant stenosis (S) in 119 (type 1, L/R, S). Only 21 patients had a "purely" bicuspid aortic valve with no raphe (type 0).Conclusions: A classification system for the bicuspid aortic valve with one major category ("type") and two supplementary categories is presented. This classification, even if used in the major category (type) alone, might be advantageous to better define bicuspid aortic valve disease, facilitate scientific communication, and improve treatment.