[A clinicopathologic study of valvular aortic stenosis in the aged]

To evaluate the usefulness of phonocardiography (PCG), carotid pulse recording (CAG) and echocardiography (UCG) used in diagnosing valvular aortic stenosis (AS) in the aged, we performed a clinicopathologic study of 23 autopsied patients with pathological evidence of aortic stenosis (AS). There were eight men and 15 women, whose ages averaged 82 years. PCG and CAG were available in 15 patients, and UCG was available in 13 patients. We classified the subjects into three groups; Group A with calcified AS, Group B with bicuspid AS and Group C with rheumatic AS. The following results were obtained. There were 12 patients in Group A, four in Group B and seven in Group C. Patients in Group A were older than those in Group B or C (A; 84-year-old, B; 80-year-old, C; 79-year-old on the average). The mean heart weight of Group A was less than that of Group B or C (A; 345 g, B; 453 g, C; 486 g). Congestive heart failure was more frequent in Groups B and C than in Group A. The fourth heart sound was recorded on the PCG in nine of 11 patients without atrial fibrillation, but there was no difference in incidence among the three groups. An ejection systolic murmur was recorded in all cases and a diastolic murmur of aortic regurgitation in 10. No patients had shudder formation on the CAG. The T-time tended to be prolonged in AS, especially in Groups B and C. The peak of the systolic murmur tended to be late in systole in Groups B and C. A1-peak/LVET was significantly increased in Groups B and C (A; 0.38, B; 0.51, C; 0.47). The decreased amplitude of aortic valvular opening (AVO) and the dense diastolic echo of the aortic valve were observed in all AS cases. The AVO of Group A was significantly less in amplitude than that of Group C (A; 3.6, C; 6.4). Thus, we could differentiate Group A from Groups B and C by various non-invasive techniques. These findings may be attributed to the different anatomic features of the aortic valves among these three groups.