Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: Clinical relevance to the Ross procedure
Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: Clinical relevance to the Ross procedure
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DOI：
10.1016/s0022-5223(99)70002-4
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发表时间：
1999-10-01
影响因子：
6
通讯作者：
David, TE
中科院分区：
文献类型：
--
作者：
de Sa, M;Moshkovitz, Y;David, TE
目的：二叶式主动脉瓣疾病常与主动脉根部和升主动脉扩张相关，本研究探讨了有或无主动脉瓣疾病患者的升主动脉和主肺动脉的组织学特征。方法：从20例二叶式主动脉瓣患者和11例三叶式主动脉瓣疾病患者的手术时采集了升主动脉和主肺动脉样本。此外，还从主动脉瓣正常的尸检病例中获取样本，根据退行性改变的严重程度将组织学变化分级为1至3级。结果：在升主动脉中，二尖瓣患者的囊性内侧坏死（P = .001）、弹性碎裂（P = .002）和平滑肌细胞方向改变（P = .002）的严重程度明显比三尖瓣疾病患者严重，在肺干标本中，二尖瓣患者的这 3 个组织学特征也明显比三尖瓣患者严重（分别为 P = .001、P = .01 和 P = .04）。 75% 的二尖瓣主动脉瓣疾病患者出现 3 级退行性改变，而三尖瓣主动脉瓣疾病患者中只有 14% 出现类似程度的退行性改变。结论：二尖瓣主动脉瓣疾病患者的升主动脉和主肺动脉中层退行性改变较三尖瓣主动脉瓣疾病患者更为严重。这些发现可以解释二叶式主动脉瓣疾病患者的根部和升主动脉扩张以及罗斯手术后某些患者的肺自体移植物扩张。
Objective: Bicuspid aortic valve disease is often associated with dilation of the aortic root and ascending aorta, This study examines the histologic features of the ascending aorta and main pulmonary artery of patients with and without aortic valve disease, Methods: Samples from ascending aorta and main pulmonary artery were obtained at the time of the operation from 20 patients with bicuspid aortic valve and 11 patients with tricuspid aortic valve disease. In addition, samples were also obtained from autopsy cases with normal aortic valve, The histologic changes were graded from 1 to 3 according to severity of degenerative changes. Results: In the ascending aorta, the severity of cystic medial necrosis (P = .001), elastic fragmentation (P = .002), and changes in the smooth muscle cell orientation (P = .002) were significantly more severe in patients with bicuspid than in those with tricuspid aortic valve disease, In the pulmonary trunk specimens, those 3 histologic features were also significantly more severe in patients with bicuspid than those with tricuspid valves (P = .001, P = .01, and P = .04, respectively). Seventy-five percent of patients with bicuspid aortic valve disease had grade 3 degenerative changes, whereas only 14% of those patients with tricuspid aortic valve disease had similar degrees of degenerative changes. Conclusion: Patients with bicuspid aortic valve disease have more severe degenerative changes in the media of the ascending aorta and main pulmonary artery than patients with tricuspid aortic valve disease. These findings may explain root and ascending aortic dilation in patients with bicuspid aortic valve disease and pulmonary autograft dilation in certain patients after the Ross procedure.