Senile heart valve disease

Introduction to senile valvular heart disease Age-related valvular heart disease (complications of degenerative cardiacvalvular calcification in the elderly) refers to the original normal valve or on the basis of mild valvular abnormalities, with the increase of age, the degenerative changes and fibrosis of the connective tissue of the heart valve, so that The valve is thickened, hardened, deformed, and deposited with calcium salts, resulting in stenosis and/or insufficiency of the valve. basic knowledge The proportion of sickness: 0.01% Susceptible people: the elderly Mode of infection: non-infectious Complications: arrhythmia heart failure aortic insufficiency aortic stenosis infective endocarditis

Causes of senile valvular heart disease

Decalcification of the bone is deposited ectopically in the valve or annulus (25%):

Sugihara et al. used a human-simulated computer system assay combined with ultrasound-detected aortic and mitral calcification to determine the effect of mineral metabolism on the aortic valve and mitral annulus calcification in elderly vertebrae. The calcium salts deposited on the ring are mainly derived from decalcification of the vertebrae.

Degeneration of the valve with age (20%):

Thompson's study found that more than 90% of CAS (calcific aortic stenosis) was caused by degenerative changes in normal valves in people over 65 years of age, whereas congenital two-valve deformities were found in aortic stenosis in the elderly. The proportion is very small, the incidence of calcific valvular disease is only 20% in the population <65 years old, and the incidence rate in the elderly over 65 years old is 3-4 times of the above age group, and the study found that valve calcification The degree of aggravation increases with age, and the incidence of multivalve involvement is also significantly increased. Therefore, most scholars believe that calcified valvular disease actually represents the change of age process and is closely related to age. Related degenerative lesions.

Abnormal carbohydrate metabolism (20%):

The Bloor study found that senile calcific valvular disease has a higher incidence in patients with diabetes and osteoarthritis, and changes in carbohydrate metabolism can significantly reverse the degree of calcification of the valve.

Gender factor (15%):

50% to 60% of elderly people with calcific valvular disease are women, although there are studies that believe that regardless of aortic valve calcification or MAC (mitral annulus calcification), there is no gender difference, but most studies show that MAC is more in women. More common, the male to female ratio is 1:2 ~ 1:4, a possible explanation is that the incidence of osteoporosis in older women is higher than that of men of the same age, this factor can affect the distribution of calcium between bone and soft tissue, while the elderly female cubit The tissue surrounding the annulus is more sensitive to injury, which is like rheumatic mitral valve disease, and the incidence of mitral stenosis in women is higher than that of men.

Increased pressure on the valve (15%):

Why senile calcific valvular disease mainly involves the aortic valve and mitral valve, the reason has not been known, may be the greatest pressure with these two valves, especially the aortic valve, increased valve force and high-speed blood flow impact easily cause annulus The injury causes tissue degeneration, fibrous tissue hyperplasia, neutral fat infiltration or collagen breakage to form a gap, which is conducive to calcium salt deposition and accelerates the process of calcification. Some scholars have found that factors that increase mitral pressure can accelerate degeneration. The process, such as idiopathic hypertrophic aortic stenosis, aortic stenosis, hypertension, etc., can increase left ventricular systolic pressure, and the mitral valve pressure is correspondingly increased, because the posterior lobe is located in the left ventricular outflow tract, It is in a position perpendicular to the pressure force, so the lesion is more obvious here. It is clinically observed that the elderly with right heart valve calcification is often accompanied by right heart volume or pressure overload, which means that the valve is calcified and the valve is The pressure to bear is closely related.

Pathogenesis

1. Pathological physiology of heart valve changes with age: There are three main forms of degenerative changes in the heart, namely calcification, sclerosing and mucinous changes. The most clinically significant in elderly degenerative heart disease is CAS (calcificy aorta) Petal stenosis) and MAC (mitral annulus calcification).

From birth to adulthood, the endocardial and atrial muscles of the atrial side of the atrioventricular valve gradually thickened, the closed margin of the valve also slightly thickened, and small nodules began to appear, with the anterior mitral lobes most obvious. It may be related to the pressure exerted by the leaflets. As the age increases, the lipid content in the annulus and fibrous tissue gradually increases. Generally, at 30 years old, the lipid in the valve begins to appear, and the calcification under the microscope is 40 years old. It is more common. After entering the old age, the collagen fibers become dense, the staining is inconsistent, the parallel arrangement disappears, and the number of myocardial nuclei decreases. The 60-year-old calcium begins to deposit along the aortic ring, and the base of the aorta is thickened significantly, forming along the closed edge of the valve. Lambert's creature (an opaque tiny papilla) slows the closure of the leaflets. As you age, the left heart valve thickens, hardens, and restricts activity. The anterior mitral valve can also Yellow lipid streaks appear, and these stripes appear as Sudanese particles and foam cells appear. These changes are mainly concentrated in the fibrous body of the valve. Blood vessels with atherosclerotic lesions can develop blood. , Calcium deposition and bleeding.

2. Anatomical features Degenerative heart valve calcification mainly involves the left heart valve, most commonly seen in the aortic valve and mitral annulus, usually without valve free edge involvement and interlobular adhesion, which can be caused by rheumatism and other inflammation The calcification of the valve is different. The calcification of the right heart valve is rare. Since 1960, there have been only a few cases of tricuspid annulus calcification, mostly in the elderly with other valvular calcification. Pulmonary valve calcification is clinical. It is rare, only one case reported that 5 cases were detected by autopsy, and all of them were coexisting with other valve calcification, and their age was significantly higher than other calcification group (mean age 81.2 years). It is speculated that the pulmonary valve may be senile calcification. The last involvement in the course of valvular disease is also the least involved group of valves. The anatomical features of CAS and MAS are briefly described below.

(1) calcified aortic stenosis: the lesions are mainly concentrated in the intima of the aortic side of the valve. Calcium generally begins from the base of the aortic surface and deposits along the aortic ring. As the degree of lesions increases, it gradually The free edge of the valve is expanded, and the light is granulated or acicular calcified. The severe calcified plaque can fill the Valsalth sinus, but there is no adhesion, fusion and fixation between the valves (Fig. 1). Therefore, even if the calcification of the valve is serious, The valve is still active, only the closing speed is significantly slowed down, and the transvalvular pressure difference does not change much. The calcification of the aortic valve is mostly affected by 2 or 3 leaflets, but the degree of lesion is different, generally no crown flap and right. The crown flap is heavier than the left coronary valve and can also extend down to the fiber triangle. However, when there is calcium deposition at the junction between the muscle and the membrane, it can compress and involve the cardiac conduction system, causing different degrees of heart block or causing Various arrhythmia.

(2) mitral annulus calcification: the lesion mainly involves the following parts:

1 mitral annulus.

2 Between the posterior ventricular surface of the mitral valve and the corresponding left ventricular endocardium, a "C" shaped calcified ring can be formed along the annulus in severe cases.

3 Calcification extends to the left atrium, around the left ventricle and the mitral valve hole, forming a stiff stent, limiting the movement of the posterior valve, which can lead to mitral stenosis or insufficiency. In general, the valvular calcification is more than the leaflet, and each The leaflets can often be involved at the same time. The posterior lobe thickening and calcification are less severe than the anterior and aortic valves. The lesions mainly involve the fibrous tissue of the valve and the base of the mitral valve leaflets. The cusps and mitral closed margins are often not affected. When calcification involves most of the tissue of the annulus, the tissue on the valve and the valve are thickened and hardened, the leaflets are distorted, and the posterior mitral valve is displaced to the atrial side. As the lesion is aggravated, the annulus is fixed and cannot be separated. The chamber shrinks and shrinks, which causes the left ventricle to deform. Because it generally does not cause adhesion and fusion between the rims, the valve lobes generally do not have severe stenosis. Only when the calcified material between the rims protrudes into the heart chamber can the flap be used. The mouth is relatively narrow, so the actual MAC is caused by the annulus stenosis, rather than the stenosis caused by the leaflet fusion caused by rheumatic valvular disease. In addition, the calcification and atherosclerosis of the fibrous tissue in the annulus can make the annulus Lose positive It comprises about role, which is the main reason for the occurrence of mitral regurgitation.

Because of the atrioventricular node, the anatomical relationship between the His bundle and the mitral valve scaffold is very close. Therefore, the degenerative change of the mitral annulus can directly affect the conduction system. The anatomical position of the sinus node is far from the mitral valve. However, the degenerative changes of the mitral annulus and the diffuse sclerosis in the conduction system coexist, and the MAC often extends to the left atrium, blocking the conduction block in the room or the room, and the incidence of MAC combined with sick sinus syndrome is high. It reflects the diffuse degeneration of the whole myocardial fibrous tissue. It is also found that the patients with MAC combined with conduction disorder are significantly higher than CAS. Nair is found in patients with calcific valvular disease who have a severe conduction disorder and need to install a pacemaker. MAC has a permanent pacemaker implant rate of 33%, while MAC-free CAS patients only 10%, so it can be considered that MAC is often a local manifestation of extensive myocardial calcification, the heart of elderly patients with atherosclerosis Transmission system dysfunction is mainly related to MAC.

3. Histological changes The degeneration of the valve can be seen from the basal part under the light microscope. The lesion mainly involves the fibrous layer. With the increase of age, the collagen fibers of the valve proliferate, dense, blurred edges, disordered arrangement and mucoid degeneration. The deep to shallow layers of the fiber gradually expand into a "petal"-shaped light-stained area, with collagen and elastic fiber filaments connected at the edges and inside, and lipid accumulation, nucleus pyknosis, reduction, elastic fiber disintegration, valvular sponge layer and The collagen elastic fiber separation between the fibrous layers does not destroy and disappear. The fine calcium salt particles are first deposited in the mucoid degeneration and lipid accumulation areas of the collagen fibers at the base of the valve, and expand with mucoid degeneration and lipid aggregation. In severe cases, the entire leaflet fiber layer is involved, forming multifocal, amorphous calcium spots, surrounded by fibrous tissue, thin-walled vascular hyperplasia and hemorrhage, inflammatory cell infiltration, occasional foreign body-like giant cells, aortic valve and two Severe calcium plaque formation in the anterior cusp is mainly seen in the middle and distal part of the valve leaflet, and the semilunar valve can also be affected, while the posterior calcification of the mitral valve is dominated by the annulus (Figure 4 ).

Electron microscopy showed that the cell components in the valve were significantly reduced, the fibroblasts shrank in a rhomboid shape, the nucleus was condensed, and the degenerated mitochondria and vacuolar remnants were seen in the cytoplasm. Matrix vesicles were observed in the extracellular matrix, and the latter were calcified and aggregated. Some scholars have confirmed that the vesicles in the valve originate from the autophagic vacuoles of the cytoplasm of senescent fibroblasts, which are released into the matrix as the cells disintegrate. The vesicles with lipid membrane structure are under light microscope. Lipids, in which acidic phospholipids have a strong binding force with calcium.

4. The degree of calcification of the valve can be divided into 4 grades according to the calcification of the valve under the light microscope.

Grade 0: No calcium deposits were observed under the microscope, with or without the degeneration of connective tissue of the valve fibers.

Grade I: Focal fine dusty calcium deposits.

Grade II: focal intensive coarse dusty calcium deposits or multifocal dusty calcium deposits.

Grade III: Diffuse or multi-focal dense coarse dusty calcium deposits, partially fused into small pieces.

Grade IV: amorphous calcium spot formation.

Some people also divided it into light and medium weight according to the degree of valve stiffness and calcification, mild: mild thickening of the valve, hardening, focal point-like calcium deposition; moderate: valve thickening, hardening, tile The sinus has diffuse spotted or needle-like calcium deposits, and the annulus is multifocal calcification; severe: obvious thickening of the valve leaflets, stiff deformation, or adhesion between the petals, nodular calcium deposits in the sinusoidal sinus, The calcification of the annulus region fuses into a "C" shape, or calcification affects the surrounding myocardial tissue.

5. Coexistence with other heart diseases Wang Zhusheng observed 52 cases of degenerative valvular disease and coexisting heart disease, indicating that most of the coexisting hypertensive heart disease, and mainly aortic valve, may be due to long-term blood pressure rise High, the mechanical stress of the aortic valve is large, causing collagen fibers to break into gaps, which is beneficial to calcium salt deposition and aortic valve calcification. The detection rate of coronary heart disease is significantly higher than that of pulmonary heart disease, but at the same time, there are two types of heart disease. The rate of outflow is low. The high-cardiac disease is mostly calcified by the right aortic valve and the non-crown valve. In coronary heart disease, the left coronary valve, the aortic annulus, the aortic three-valve and the aortic valve combined with the mitral annulus are more common. The more coexisting heart disease, the more serious the damage to heart function.

Senile valvular heart disease prevention

Since the exact cause and pathogenesis of this disease have not yet been fully clarified, no breakthrough has been made in the study of preventive measures. The current preventive measures:

1. Active treatment of prone factors such as treatment of hypertension, hyperlipidemia, diabetes, coronary heart disease, subaortic stenosis.

2. Active prevention and treatment of complications such as cardiac insufficiency, arrhythmia, infective endocarditis, thrombosis, etc.

With the increasing emphasis on the disease and the further study of the mechanism, it is believed that in the near future, effective measures to delay cardiac degeneration, prevent and treat valvular calcification will be found, and the incidence and mortality will be greatly reduced. .

Complications of senile valvular heart disease Complications arrhythmia heart failure aortic valve insufficiency aortic stenosis infective endocarditis

Arrhythmia, heart failure, calcific aortic insufficiency, calcific aortic stenosis, infective endocarditis, cerebrovascular accident and other complications may occur.

Arrhythmia

Approximately 80% of patients with degenerative heart valve disease have arrhythmia, including atrial arrhythmia, atrioventricular block, sick sinus syndrome, severe arrhythmia can lead to heart failure and even sudden death, a case of 88 cases Analysis of patients with degenerative heart valve disease showed that 56.8% of patients with concurrent arrhythmia, including atrial fibrillation accounted for 23.9%, pre-contraction accounted for 17%, bundle branch block accounted for 11.4%, and atrioventricular block accounted for 4.6%.

2. Heart failure

It has been reported that 35% to 50% of patients have congestive heart failure, and cardiac function is mostly between grades II and III. Another study shows that 62.5% of patients with degenerative valvular heart disease develop heart failure, the vast majority of which For left heart failure, the annual mortality rate of patients with heart failure is 15%.

3. Aortic valve insufficiency

Due to calcification, stiffness, and deformation of the valve, eventually leading to insufficiency or stenosis of the valve, it has been reported that in patients with degenerative valvular disease, aortic valve calcification accounted for 69.2%, and aortic insufficiency accounted for 37.2%.

4. Aortic stenosis

Epidemiological data show that in the elderly over 65 years, aortic valve calcification caused stenosis accounted for 2% to 9%, in patients over 75 years old, 5% of patients with mild to moderate calcific aortic stenosis, severe stenosis 3%, with an increase in age, the average annual aortic valve area will be reduced by 0.1cm ² .

5. Sudden cardiac death

It is the most serious complication of degenerative heart valve disease. Because degenerative heart valve disease can cause fatal arrhythmia, heart failure, valvular stenosis and insufficiency, the occurrence of sudden death is not uncommon. It is reported that about 20%-25 % of patients with degenerative heart valve disease are prone to sudden death.

6. Infective endocarditis

As the detection rate of degenerative heart valve disease continues to increase, the incidence of infective endocarditis caused by this disease has increased compared with the previous one, as reported by 15%.

7. Nervous system complications

According to data, once the mitral annulus is calcified, the risk of cardiogenic embolic stroke is increased by 2 to 4 times. A domestic study confirmed that mitral calcification complicated with cerebral infarction accounted for 26.8%, indicating mitral calcification It is the basis of thrombosis.

Symptoms of senile valvular heart disease Common symptoms Heart valve perforation fatigue conduction block heart valve disease weakness systolic murmur sinus node disease abscess myocardial infarction bacterial endocarditis

Calcified valvular disease in the elderly progresses slowly, causing stenosis and/or insufficiency of the valve, and has little effect on hemodynamics. Therefore, there is no obvious symptom for a long time, and even subclinical for life, generally not easy to cause The attention of patients and doctors, Otto et al. Clinically, 123 patients with aortic stenosis symptoms, echocardiography and other results showed that 71% of patients with aortic valve calcification, plus the elderly often combined with other parts Degenerative changes or associated with other cardiopulmonary disorders, such as hypertension, coronary atherosclerosis and lung, cerebrovascular disease, etc., can conceal the original symptoms and signs, once in the clinical stage, angina, syncope and approximate syncope and congestion Sexual heart failure, etc., often indicates that the lesions have been severe. Bloor believes that the symptom period can last from 1 to 18 years, while Braunwald found that the average survival time of patients in this period is only 3 years, and the sudden death rate is about 15%.

In the General Hospital of the People's Liberation Army, 95 patients with calcified valvular disease and valvular calcification in elderly patients with echocardiography were followed up for 6 years. The anterior murmur of the valvular calcification group, heart enlargement, sinus node lesion, conduction The incidence of obstruction and atrial fibrillation, heart failure, myocardial infarction, cerebrovascular disease, and syncope was significantly increased.

There are many significant differences between senile calcific valvular disease and valvular heart disease in middle-aged people under 65 years of age. The following is a brief description of the clinical features of common calcific valvular disease.

CAS: The most common symptoms of severe calcified aortic stenosis in the elderly are dyspnea and heart failure, while angina is a common symptom of aortic stenosis in young and middle-aged patients. This disease can also produce angina pectoris, its clinical features and coronary heart disease. The angina pectoris is similar, and the two are easily confused. Especially when the two coexist, it is difficult to identify. It is not uncommon to have syncope. It may be related to ventricular arrhythmia, conduction block, etc. If the mitral annulus calcification coexists, the incidence is higher. Exercise syncope may be associated with an increase in cardiac output during exercise and insufficient blood supply to the brain. Other symptoms include weakness, palpitations, long-term atrial fibrillation or slow arrhythmia in some patients, which may cause thrombosis, embolism or calcification in the atria. Block detachment can produce symptoms of systemic embolism. Many patients are admitted to hospital with cerebral infarction and neglect the basic valvular calcification of calcified emboli. Older patients are often accompanied by right colon vascular disease, and lower gastrointestinal bleeding occurs. When extensive calcification occurs in the ventricular septum, the atrioventricular node, the His bundle and its surrounding conduction tissue may be involved. disfunction.

Systolic murmurs in the aortic valve area are more common, but unlike general aortic stenosis, the best auscultation area is often at the apex of the heart, rather than at the bottom of the heart (Callavardin effect), multi-directional inferior orbital conduction, but not Neck conduction, loudness is moderate, moderate, can be music-like, due to valve calcification, elasticity disappears and fixed, often no early contraction (click) sound, Aronow and Roberts and other studies pointed out that elderly aortic stenosis The jet sound lacks specificity, and the intensity of the noise, the most loud part, and the conduction direction are meaningless to distinguish the severity of aortic stenosis. When atrial fibrillation occurs, the heart rhythm is absolutely irregular. Due to arteriosclerosis, vascular compliance is reduced. The systolic blood pressure is not significantly reduced or even increased, but the diastolic blood pressure is lower, so the pulse pressure difference is normal or widened. Unlike general aortic stenosis, the aortic regurgitation murmur is less (only 4%). However, once a diastolic murmur occurs, the degree of calcification of the aortic valve is heavier.

MAC: Most of the mitral calcification in the elderly has no obvious clinical symptoms. When the mitral annulus is involved, the mitral valve activity is limited, but it cannot be reduced in the systolic phase like the normal valve. When the severe annulus calcification involves the posterior valve. When the activity is affected, the mitral insufficiency may occur. When the condition is severe, the patient may have a feeling of extreme fatigue due to low cardiac output, and the activity endurance is limited. Some patients may also cause stenosis, but the degree is Light, severe stenosis is extremely rare, because the calcification on the mitral annulus generally does not cause hemodynamic changes, but when the calcification is larger, apparently protruding into the heart chamber, the valve can be relatively narrowed. Causes hemodynamic deterioration, even congestive heart failure, and labor or nighttime paroxysmal dyspnea, Aronow study found that in the apex of the elderly, if there is diastolic murmur, the possibility of MAC is up to 90%, and the degree of lesions is mainly focused on those with only systolic murmur.

The signs of mitral insufficiency caused by calcific valvular disease are similar to those of general chronic mitral stenosis. When mitral regurgitation occurs, left atrial pressure can be increased, left atrial enlargement and atrial arrhythmia occur. Atrial fibrillation has 68.2% of left atrial enlargement, Aronow reported that atrial fibrillation is only 27.8% of normal left atrial size, and mitral regurgitation is easy to be complicated by bacterial endocarditis, even in the annulus Abscesses occur around the calcification, and when the calcification invades the valve leaflets, thrombosis can occur. The most fatal aortic emboli are mostly calcified tumor-like masses. The embolism can cause embolism of important organs such as the brain and retina. Nair reports MAC-induced The incidence of cerebral embolism is about 11%. Patients with this disease have no clinical symptoms in the early stage, and the late symptoms of disease development, such as angina pectoris, heart failure and syncope, are also non-specific. This degenerative change leads to corresponding stenosis or regurgitation, and the noise caused by it can be further examined. The clue, but it is worth noting that there is often no corresponding relationship between the murmur site and the pathological changes of the valve. The aortic valve lesion murmur is not necessarily heard in the aortic valve area, often in the mitral valve area, and the majority of patients with single valve disease can be more The part is murmur, which makes it difficult for clinical diagnosis. However, with the development of ultrasound technology, the diagnostic sensitivity of the disease has reached 70%. Combined with electrocardiogram and X-ray examination, the diagnosis rate can be further improved, and other cardiovascular diseases can be excluded. Calcification caused by disease.

Examination of senile valvular heart disease

Electrocardiogram

Mild senile calcific valvular disease has normal ECG. Aortic valve disease may have left ventricular hypertrophy. In addition to left ventricular hypertrophy, mitral annulus calcification may have a prolonged or appearing P wave duration due to enlargement of left atrium. Incision, V1 lead ptf negative value increases, because this disease often involves the cardiac conduction system, it often has one to three degrees of atrioventricular block, left bundle branch block or left anterior block diagram, 20% to 30% of patients Atrial fibrillation or other arrhythmia can occur.

2. Echocardiography

Takamoto et al. compared ultrasound with autopsy or postoperative pathological examination and found that the sensitivity of ultrasound diagnosis is about 70%. It is the main method for clinical diagnosis of this disease. Two-dimensional echocardiography can directly observe the location, morphology and morphology of valvular calcification. The movement of the leaflets, but it is difficult to quantitatively judge the degree of stenosis. Ultrasound Doppler and color Doppler flow imaging have solved this problem well. Recent studies have found that Doppler is continuous. Wave measurement of the transvalvular pressure gradient and the area of the valve was well correlated with the results measured by the catheter (r = 0.75, P = 0.002), so that ultrasound can detect calcific valvular disease and determine the sensitivity and location of the lesion. The specificity is greatly improved, not only can monitor hemodynamic changes, evaluate valve function, provide assistance for clinical condition analysis, guidance treatment, prognosis judgment, but also provide objective basis for selecting surgical indications and surgical methods.

The characteristic change of senile aortic valve calcification is the obvious abnormal thickening of the valve, the activity is reduced, the valve opening and closing dysfunction, the echo is obviously enhanced by calcification, especially the annulus and the valve body are obvious, if involved The ventricular septum can also have corresponding echo enhancement. He Jun et al. used the valve valvular calcification to be greater than the aortic root echo as the diagnostic criteria, while the aortic wall as the ultrasound reference for the evaluation of heart valve calcification may be an intuitive Practical methods, other signs of general aortic stenosis and insufficiency can be seen.

When the mitral annulus is calcified in the M-mode echocardiography, the anterior wall of the left ventricle can be found. The posterior wall of the left ventricle is anomalous, and the reflection is strong, parallel to the posterior wall of the left ventricle. The echogenic band, suggesting the calcification of the annulus, and showing that the amplitude of the anterior mitral regurgitation is reduced, the EF slope is slow, and the left ventricle is enlarged. The two-dimensional ultrasonography shows the posterior mitral lobes and left ventricle. There is a uniform crescent-shaped echo zone between the posterior wall. The long axis view or apical zone of the anterior region can show an abnormally strong echo zone in front of the junction of the atrioventricular. The direction of motion of this echo and the direction of the posterior wall of the left ventricle Consistent, and not connected to the left atrium and left ventricle, Doppler can show turbulence caused by systolic blood return during left ventricular systolic, and contrast agent can return to the left atrium from the left ventricle during systole.

3. X-ray and CT examination

Ordinary chest radiographs can show aortic calcification, high exposure techniques or tomography can increase the detection rate, such as patchy, linear or banded calcification shadows in the aorta and / or mitral annulus, For the diagnosis, in addition, there may be X-ray signs corresponding to aortic valve and mitral stenosis and insufficiency. In addition, Woodring et al reported that CT can improve detection in early senile calcific valvular disease, which was not detected by some ultrasound. Rate, and is considered to be more sensitive and specific than ultrasound, but it is not a routine detection method.

Diagnosis and diagnosis of senile valvular heart disease

Diagnostic criteria

The disease lacks a unified diagnostic standard, and comprehensive literature reports propose the following diagnostic criteria:

1 age is over 60 years old.

2 Echocardiography has typical valve calcification or annulus calcification. The lesion mainly involves the annulus, the base of the valve and the valve, and the junction of the cusp and the valve leaflet is rarely affected.

3X-ray examination includes image-enhanced fluoroscopy, high-pressure radiography or angiography with calcified shadows of the valve or annulus.

4 Clinical or other examination evidence with valvular dysfunction.

5 other factors caused by valvular lesions, such as rheumatic, syphilis, papillary muscle dysfunction, chordae rupture and infective endocarditis, no congenital connective tissue abnormalities and abnormal calcium or phosphorus metabolism disease or medical history.

Differential diagnosis

The disease generally does not occur with valve adhesion and leaflet edge deformation. Combined with medical history, physical examination and biochemical examination can be distinguished from other valvular diseases caused by inflammation, etc. It is worth noting that some elderly patients with rheumatic heart valve disease Calcification occurs in the body of the valve leaflet. What kind of leaflet lesions belong to it? In addition to pathological examination, the existing methods are often difficult to identify, and it is possible for both to coexist.

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