２７年間経過を観察し進行性狭心症と心不全を呈して死亡した高齢者先天性大動脈二尖弁の１剖検例

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  • An Autopsied Case with a Bicuspid Aortic Valve Who Had Progressive Angina Pectoris and Heart Failure during Follow-up of 27 Years.
  • ショウレイ ホウコク 27ネンカン ケイカ オ カンサツ シ シンコウセイ キョウシンショウ ト シンフゼン オ テイシテ シボウ シタ コウレイシャ センテンセイ ダイドウミャク 2 センベン ノ 1 ボウケンレイ

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A Japanese man who died at age 85 had been followed since the age of 59, when he first presented. He had hypertension of 162/102mmHg and a loud systolic murmur on his first visit. He had had an active daily life without any medication for the next 10 years. At the age of 72 he complained of mild chest discomfort on exercise. Although electrocardiography showed no abnormalities, echocardiogram showed calcified bicuspid aortic valve with mild stenosis. At the age of 81 the dyspnea and chest oppression were exacerbated, associated with marked ST depression on exercise electrocardiogram and restriction of aortic valve opening on echocardiograms. In the following years a gradual increase in QRS voltage and ST depression with T wave inversion were recorded on resting electrocardiograms and sharp increases in both left ventricular end- diastolic diameter and flow velocity at the aortic root were observed on echocardiograms. At the age of 85 he died of intractable heart failure with massive pleural effusion. Autopsy revealed marked hypertrophy and moderate dilatation of the heart (weight: 580g). The bicuspid aortic valve had anterior-posterior cusps with a raphe on the anterior cusp. The mobility of the cusps was almost lost because of severe calcification and thickening. Severe stenosis was found near the orifice of the right coronary artery, but there were no significant ischemic myocardial lesions.

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