Abstract
Since age is no longer considered an additional risk factor for cardiac surgery, the epidemiology of valve disease in the elderly at present may be estimated from the surgical pathology evaluation of valve specimens which are resected at the time of valve replacement. In the time interval 1991–1993, 500 patients underwentnative cardiac valve replacement or repair at our University, with a total of 549 valves available for gross and histological examination. Single valve surgery was performed in 451 patients (300 aortic, 148 mitral, 3 tricuspid), and double valve replacement in 49 (47 mitral- aortic, 1 aorto- tricuspid and 1 mitral- tricuspid). Two hundred and eighteen patients (44%) were older than 65 years; the mean age was 70.4± 4.3 years, and the male to female ratio was 0.9 to 1. Two- thirds of the interventions in the elderly group were aortic operations. However, regardless of the age group, 50 and 60% of the cases with respectively aortic and mitral valve disease were due to rheumatic disease. Age- related degenerative valve diseases were prominent; senile dystrophic calcification with aortic stenosis mostly in the elderly, anuloaortic ectasia with aortic incompetence mostly in adults, and floppy valve with mitral incompetence in both age groups. Bicuspid aortic valve, a congenital anomaly which is silent until adulthood, accounted for both aortic stenosis and stenoincompetence by dystrophic calcification, and pure aortic incompetence by endocarditis or anuloaortic ectasia. Our findings suggest that although age- related degenerative valve diseases are increasing, rheumatic disease still remains the leading cause of valve dysfunction in our country even in the elderly. These data may have an impact on prevention strategies and health- care costs.However, it has to be pointed out that the high prevalence of rheumatic disease is a feature of this particular study but is different from the findings of other studies around the world. (Aging Clin. Exp. Res. 6: 225–237, 1994)
Similar content being viewed by others
References
Acar J., Michel P.I., Dorent R., Luxereau P., Vahanian A., Cormier B., Veron P.: Evolution des étiologies des valvulopathies opérées en France sur une période de 20 ans. Arch. Mal. Coeur 85: 411–415, 1992.
Passik C.S., Ackermann D.M., Pluth J.R., Edwards W.D.: Temporal changes in the causes of aortic stenosis: a surgical pathology study of 646 cases. Mayo Clin. Proc. 62: 119–123, 1987.
Fremes S.E., Goldman B.S., Ivanov J., Weisel R.D., David T.E., Salerno T.: Valvular surgery in the elderly. Circulation 80: I 77–190, 1989.
Gillum R.F.: Nonrheumatic valvular heart disease in the United States. Am. Heart J. 125: 915–918, 1993.
Dare A.J., Veinot J.P., Edwards W.D., Tazelaar H.D., Schaff H.V.: New observations on the etiology of aortic valve disease: a surgical pathologic study of 236 cases from 1990. Hum. Pathol. 24: 1330–1338, 1993.
Turn M., Thiene G., Bortolotti U., Milano A., Mazzucco A., Gallucci V.: Surgical pathology of aortic valve disease. A study based on 602 specimens. Eur. J. Cardiothorac. Surg. 4: 556–560, 1990.
Subramanian R., Olson L.J., Edwards W.D.: Surgical pathology of pure aortic stenosis: a study of 374 cases. Mayo Clin. Proc. 59: 683–690, 1984.
Subramanian R., Olson L.J., Edwards W.D.: Surgical pathology of combined aortic stenosis and insufficiency: a study of 213 cases. Mayo Clin. Proc. 60: 247–254, 1985.
Gordis L.: The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. Circulation 72: 1115–1162, 1985.
Dolara A., Santoro G., Zuppiroli A.: Le cardiopatie valvolari acquisite in Italia: dimensioni del problema e variazioni nella etiologia. Cardiologia 38: 185–190, 1993.
Olson L.J., Subarmanian R., Edwards W.D.: Surgical pathology of pure aortic insufficiency: a study of 225 cases. Mayo Clin. Proc. 59: 835–841, 1984.
Guiney T.E., Davies M.J., Parker D.J., Leech G.J., Leatham A.: The aetiology and course of isolated severe aortic regurgitation: a clinical, pathological and echocardiographic study. Br. Heart J. 58: 358–368, 1987.
Roberts W.C.: The senile cardiac calcification syndrome. Am. J. Cardiol. 58: 572–574, 1986.
Giusti S., Cocco P., Thiene G.: Valvola aortica bicuspide: una cardiopatia congenita “minore” a rischio di gravi complicanze. G. Ital. Cardiol. 21: 189–201, 1991.
Peterson M.D., Roach R.M., Edwards J.E.: Types of aortic stenosis in surgically removed valves. Arch. Pathol. Lab. Med. 109: 829–832, 1985.
Roberts W.C., Morrow A.G., Mclntosh C.L., Jones M., Epstein S.E.: Congenially bicuspid aortic valve causing severe pure aortic regurgitation without superimposed infective endocarditis. Analysis of 13 patients requiring aortic valve replacement. Am. J. Cardiol. 47: 206–209, 1981.
Roberts W.C.: Morphologic aspects of cardiac valve dysfunction. Am. Heart J. 123: 1610–1632, 1992.
Van Der Bel- Kahn J., Becker A.E.: The surgical pathology of rheumatic and floppy mitral valves. Distinctive morphologic features upon gross examination. Am. J. Surg. Pathol. 110: 282–292, 1986.
Olson L.J., Subramanian R., Ackermann D.M., Orszulak T.A., Edwards W.D.: Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin. Proc. 62: 22–34, 1987.
Rose A.G.: Etiology of acquired valvular heart disease in adults. Arch. Pathol. Lab. Med. 110: 385–388, 1986.
Turri M., Thiene G., Bortolotti U., Mazzucco A., Gallucci V.: Surgical pathology of disease of the mitral valve with special reference to lesions promoting valvar incompetence. Int. J. Cardiol. 22: 213–219, 1989.
Agozzino L., Falco A., de Vivo F., de Vincentiis C., de Luca T.S.L., Esposito S., Cotrufo M.: Surgical pathology of the mitral valve: gross and histological study of 1288 surgically excised valves. Int. J. Cardiol. 17: 79–89, 1993.
Dare A.J., Harrity P.J., Tazelaar H.D., Edwards W.D., Mullany C.J.: Evaluation of surgically excised mitral valves: revised recommendations based on changing operative procedures in the 1990s. Hum. Pathol. 23: 1286–1293, 1993.
Hanson T.P., Edwards B.S., Edwards J.E.: Pathology of surgically excised mitral valves. Arch. Pathol. Lab. Med. 109: 823–828, 1985.
Waller B.F., Morrow A.G., Maron B.J., Del Negro A.A., Kent K.M., McGrath F.J., Wallace R.B., Mclntosh C.L., Roberts W.C.: Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am. Heart J. 104: 276–288, 1982.
Roberts W.C., Mclntosh C.C., Wallace R.B.: Mechanisms of severe mitral regurgitation in mitral valve prolapse determined from analysis of operatively excised valves. Am. Heart J. 113: 1316–1323, 1987.
Davies M.J., Moore B.P., Braimbridge M.V.: The floppy mitral valve. Study of incidence, pathology, and complication in surgical, necropsy and forensic material. Br. Heart J. 40: 468–481, 1978.
Thiene G., Valente M.: Degenerative, non-atherosclerotic cardiovascular disease in the elderly: a clinico-pathological survey. Aging Clin. Exp. Res. 2: 231–244, 1990.
Davies M.J.: Pathology of cardiac valves. Butter-worth, London-Boston, 1980.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Angelini, A., Basso, C., Grassi, G. et al. Surgical pathology of valve disease in the elderly. Aging Clin Exp Res 6, 225–237 (1994). https://doi.org/10.1007/BF03324247
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324247