CAUSES OF ISOLATED AORTIC-INSUFFICIENCY IN AN URBAN-POPULATION IN THE1990S - A REVIEW OF 56 SURGICAL PATHOLOGY CASES

Until recently, the cause of isolated aortic insufficiency (AI) was us ually thought to be inflammatory or rheumatic in most cases. However, at our institution we have noted a high prevalence of myxomatous degen eration (MD) in aortic valves removed for AI. In this study we report anatomic observations on valves from 56 consecutive patients with isol ated AI undergoing aortic valve replacement surgery. Fifty-six consecu tive aortic valves removed at our institution from 1994 to 1996 for is olated AI and/or aortic aneurysm were reviewed. Anatomic features were compared with clinical history and echocardiographic data. The anatom ic results were also compared to 22 age-matched control aortic valves obtained at autopsy. In 13/56 cases (23%), a specific valvular cause o f AI was determined (infectious endocarditis, seven cases; chronic rhe umatic disease, four cases; congenital bicuspid valve, two cases). Of the remaining (idiopathic) 43 cases, 18 (42%) had severe isolated MD d efined as >50% expansion of the spongiosa and disruption of the fibros a by the deposition of acid mucopolysaccharides in the absence of seve re calcification, fibrosis, or other pathologic findings. Only 1/22 ao rtic valves from the autopsy controls had severe MD. Eighteen of the 5 6 patients also had a clinical history of aortic dilatation/aneurysm o f which 12 were confirmed to be dilated by echocardiographic criteria. Of these 12, five (42%) had MD of the aortic valve only, three (25%) had both MD and cystic medial degeneration (CMD) of the aorta, two (17 %) had CMD of the aorta only, and two (17%) had no specific diagnosis. Isolated MD of the aortic valve is the most common cause of isolated AI in our patient population. Furthermore, in a subset of non-Marfan's patients with both AI and dilatation of the aortic root/aortic aneury sm the incidence of MD is even higher (67%). These results suggest tha t there is overlap between MD and CMD in non-Marfan's patients and tha t both entities may be part of a spectrum of a generalized connective tissue disorder. (C) 1998 by Elsevier Science Inc.