[Clinicopathologic study of congenital bicuspid aortic valve in the aged]

Congenital bicuspid aortic valve was found in 25 patients(18 men, 7 women, mean age 78 years) of 7,000 consecutive autopsy cases over 60 years old(0.36%). Nine cases showed aortic stenosis(Group AS), 7 cases showed aortic stenosis and regurgitation(Group ASR) (4 cases with stenosis dominancy, 3 cases with regurgitation dominancy), 9 cases showed no aortic stenosis or regurgitation(Group Non-ASR) and no cases showed pure aortic regurgitation. The groups were compared clinically and pathologically. Cardiac death was frequently found in Groups AS and ASR. The aortic valve was the thickest in Group AS(6.0 +/- 2.1 mm), and thicker in Group ASR (4.6 +/- 1.8 mm) than in Group Non-ASR(2.3 +/- 1.1 mm). Seventeen cases(68%) had right-left cusps of the aortic bicuspid valve and 8 cases(32%) had anterior-posterior cusps. Raphe was seen in 18 cases(72%) and was more frequent in Groups ASR and Non-ASR than in Group AS. Especially, all cases had raphes in Group Non-ASR. Calcification was severe in Group AS and in cases with stenosis dominancy in Group ASR. However, calcification was limited in cases with regurgitation dominancy in Group ASR. Calcification was limited or not present in Group Non-ASR. In this study, the frequency of the bicuspid aortic valve in the aged, the ratio of stenosis to regurgitation, and the distribution of calcification in the valve were established. The bicuspid aortic valve did not necessarily become stenotic, and there were cases having no stenosis or regurgitation. Especially, it was shown that cases without raphe were prone to have marked calcification and to become stenotic. On the other hand, cases with raphe were not prone to become stenotic.