New observations on the etiology of aortic valve disease: A surgical pathologic study of 236 cases from 1990

doi:10.1016/0046-8177(93)90267-K

Human Pathology

Volume 24, Issue 12, December 1993, Pages 1330-1338

https://doi.org/10.1016/0046-8177(93)90267-K Get rights and content

Abstract

Among 236 aortic valves surgically excised at the Mayo Clinic in 1990 (mean patient age, 66 years; age range, 10 to 92 years), 154 (65%) were stenotic, 58 (25%) were insufficient, and 24 (10%) were both stenotic and insufficient. Pure stenosis was related to calcification, and causes included degenerative (51%), bicuspid (36%), postinflammatory (9%), and other (4%) reasons. Fourteen (9%) valves with pure stenosis also underwent ventricular septal myectomy, 12 for hypertrophy and two for co-existent hypertrophic cardiomyopathy. Pure insufficiency was not related to calcification, and causes included aortic root dilatation (50%), bicuspid valve (14%), postinflammatory (14%), posttherapeutic (14%), and other (8%) reasons. Combined stenosis and insufficiency was secondary to degenerative calcification (46%), bicuspid and postinflammatory etiologies (17% each), posttherapeutic (13%), and indeterminate (8%) causes. New observations include the following findings: (1) degenerative (senile) disease is the most common cause of aortic stenosis and combined stenosis and insufficiency at the Mayo Clinic, (2) aortic root dilatation is the most common cause of pure aortic insufficiency, (3) posttherapeutic aortic valve disease now leads to valve replacement in a substantial percentage of patients, particularly among those with insufficiency, (4) postinflammatory (presumably rheumatic) disease is relatively uncommon in all three functional categories, (5) septal myectomy may be performed for hypertrophic states other than hypertrophic cardiomyopathy, and (6) adults with operated congenital heart disease are undergoing valve replacement for annular dilatation with insufficiency. Because of the increasing age of the general population, the prominence of age-related degenerative aortic valve calcification and aortic root dilatation may have important implications concerning future health care costs.

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^☆: Presented in part as a poster at the United States and Canadian Academy of Pathology Annual Meeting, Atlanta, GA, March 18, 1992.

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Original contributionNew observations on the etiology of aortic valve disease: A surgical pathologic study of 236 cases from 1990☆

Abstract

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Ann Thorac Surg

J Am Coll Cardiol

Ann Thorac Surg

Chest

J Am Coll Cardiol

Original contribution
New observations on the etiology of aortic valve disease: A surgical pathologic study of 236 cases from 1990☆