SURGICAL PATHOLOGY OF THE AORTIC-VALVE - GROSS AND HISTOLOGICAL-FINDINGS IN 1120 EXCISED VALVES

From January 1981 through December 1991, 1120 consecutive aortic valve s were surgically explanted and their gross anatomy and histology stud ied at our university. Rheumatic disease (65%), dystrophic calcific va lvular disease (23%), noninflammatory disease of the aortic root and/o r floppy aortic valve (6.3%), and endocarditis (5.4%) were the causes of valve dysfunction. Among the total population the male sex predomin ated. The male to female ratio was 2.4 in the group with dystrophic ca lcific valvular disease and 1.6 in the group with bacterial endocardit is. The mean age was 37 +/- 7.5 years in the group with non-inflammato ry disease of the aortic root and/or aortic cusps. In the group with d ystrophic calcific valvular disease, the mean age was 62 +/- 6.3 years . Among the 1120 patients, 717 (64.03%) underwent surgery for aortic s tenotic-incompetence, 250 (22.25%) for isolated aortic stenosis, and 1 53 (13.72%) for isolated aortic incompetence. In 449 cases (40.13%) a mitral pathology was associated. Chronic rheumatic aortic disease usua lly caused stenotic insufficiency (92.8%). Dystrophic calcific aortic disease caused pure stenosis in 84.8% of the cases. Among these, 46 pa tients (18.4%) had a congenitally bicuspidal aortic valve. Pure aortic incompetence was caused by noninflammatory aortic root and/or cusp di sease in 44% of patients, infective endocarditis in 40%, and rheumatic disease in 16%. Patients with noninflammatory aortic root and/or cusp disease were divided into three groups: 29 patients with aortic root dilatation and normal cusps, 25 patients with aortic root dilatation a nd mixomatous infiltration of aortic cusps (floppy aortic valve), and 15 patients with floppy aortic valve and normal aortic root. Aortic in competence was caused by cusp retraction caused by chronic rheumatic d isease, cusp perforation or tears caused by infective endocarditis, an d cusp prolapse for floppy aortic valve. Cusp diastasis has been the c ause of aortic incompetence in patients with dilated aortic root. In p atient with floppy aortic valve caused by the fibrous lamina disarray, the cusps prolapsed toward the left ventricle, causing valve regurgit ation.