Surgical pathology of aortic valve disease *1A study based on 602 specimens

Abstract

A consecutive series of 602 surgically excised aortic valves was evaluated by means of macroscopic and histological study. Pure aortic stenosis was diagnosed in 140 patients, pure incompetence in 254 and combined dysfunction in 208. Of the cases with pure aortic stenosis, 38% were rheumatic, 34% were calcified bicuspid valves and 23% showed dystrophic calcification. Half the patients with pure aortic regurgitation showed aortic root dilatation. Most cases of combined aortic stenosis and regurgitation were the sequelae of rheumatic fever. A male prevalence was detectable in each group (mean male: female ratio = 2.6), and was highest in infective endocarditis and aortic root dilatation. Infective endocarditis was a frequent complication of congenitally bicuspid valves. In conclusion, rheumatic disease is still a frequent cause for surgical replacement of the aortic valve. At least half the explanted aortic valves have degenerative or congenital diseases which are often the site of a superimposed infective endocarditis.

Aortic Valve Repair Using a Differentiated Surgical Strategy

“…16 Although progressive stenosis has been observed in bicuspid aortic valves, this has not occurred in those with pure regurgitation. [2][3][4]31 We have even seen patients with wellpreserved pliable cusp morphology in bicuspid anatomy up to the age of 70 years, and we found postoperative systolic gradients in our patients being within physiological range comparable to those of a stentless biological valve, but below the gradients of stented xenograft. 49 -51 We have not attempted to judge the relative advantages or disadvantages of different techniques in root or cusp repair.…”

“…6,9,10 Root dilatation has been increasingly recognized as the most common cause of pure aortic regurgitation. [2][3][4] Two different procedures have been developed in the context of valve-preserving surgery to correct this mechanism. Sarsam and Yacoub 7 propagated remodeling of the aortic root to achieve coaptation by reduction of the ST junction.…”

“…Repair of a tricuspid valve with 3 coaptation lines is more difficult than the bileaflet mitral valve; in addition, different pathologies of aortic root and cusps may contribute to valve dysfunction. [1][2][3][4] Dilatation of the aortic root is currently the most frequent cause of regurgitation. [2][3][4] Prolapse of cusp tissue in bicuspid anatomy or "floppy" tricuspid aortic valves 4 impairs coaptation by a different mechanism, especially in the presence of congenital fenestrations.…”

Frequency by Decades of Unicuspid, Bicuspid, and Tricuspid Aortic Valves in Adults Having Isolated Aortic Valve Replacement for Aortic Stenosis, With or Without Associated Aortic Regurgitation

“…Turri and colleagues 11 in 1990 described operatively excised aortic valves from 602 patients having valve replacement, but these authors combined data from patients with pure regurgitation and those with some degree of aortic stenosis. That study also included patients who had concomitant mitral valve disease, and indeed, the most common cause of aortic stenosis (Ϸ348 patients) in their patients was rheumatic heart disease (undefined; in 172 [49%]).…”

Quadricuspid aortic valves

“…Olson et al observed an incidence of 1% of quadricuspid aortic valves on review of 225 patients undergoing surgery for pure aortic insufficiency. 7 In contrast, Turri et al 8 failed to find a case of QAV on examination of 602 surgical specimens of aortic valves. Quadricuspid pulmonary valves are nine times more common than aortic valves.…”