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Journal of Medical Ultrasonics

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1995 - Vol.22

Vol.22 No.11

Original Article(原著)

(0799 - 0805)


Echocardiographic Findings of the Aortic Valve in Chronic Aortic Regurgitation with No Specific Etiology

広仲 英治1, 小島 昌治2, 本郷 実2, 深谷 幸雄3, 田中 正雄2, 石井 恵子1, 関口 守衛2

Eiji HlRONAKA1, Shoji KOJIMA2, Minoru HONGO2, Yukio FUKAYA3, Masao TANAKA2, Keiko ISHII1, Morie SEKIGUCHI2

1信州大学附属病院中央検査部, 2信州大学附属病院第1内科, 3信州大学附属病院第2外科

1Central Clinical Laboratories Shinshu University Hospital, 2First Department of Internal Medicine Shinshu University School of Medicine, 3Second Department of Surgery Shinshu University School of Medicine

キーワード : Aortic valve prolapse, Chronic aortic regurgitation, Myxomatous degeneration

We studied the echocardiographic characteristics of the aortic valves of 17 patients who had severe chronic aortic regurgitation of unknown etiology and had aortic valve replacement surgery. The study population comprised 14 men and 3 women aged 53 to 73 years (mean, 64 years). Fifteen (88%) of the 17 patients had aortic valve prolapse, which most frequently involved in the right coronary cusp (RCC) (n=13). Severity of prolapse was also higher in the RCC than in the left coronary cusp (LCC) or the noncoronary cusp (NCC). Diastolic fluttering of the prolapsed RCC was evident in 3 patients who exhibited musical diastolic murmur. Increased echo intensity of the aortic valve, especially at the tip of the cusps, observed in 9 patients, corresponded to the focal thickening of the free edges of the cusps, which was identified during surgery. Preoperative echocardiographic examination failed to correctly diagnose the aortic valve characteristics confirmed on surgery, however. These included diffuse mild thickening, thinning, retraction, perforation, and tearing. Histopathologic examination of the excised valves showed myxomatous degeneration in all but one, despite the echocardiographic and surgical findings. We conclude that severe chronic aortic regurgitation without a specific etiology is caused mainly by myxomatous degeneration that results in aortic valve prolapse in elderly patients. Echocardiographic findings, such as prolapse, increased echo intensity of the cuspal tip, and diastolic fluttering of the aortic valve, suggest myxomatous changes in the valve.