RESUMO
Objective To investigate the relation between macrophage infiltration and degree of calcific aortic stenosis (CAVS)in elder patients.Methods The aortic valve specimens were collected from 2012 September to 2014 March in Depart‐ment of Cardiac Surgery of Hainan General Hospital ,for operation removal ,from 80 cases[40 males and 40 females ,age:(58 ± 6)years old];normal aortic valve specimens were collected from 7 patients undergoing surgical removal of the normal aortic valve because of aneurysm[4 males ,3 female patients ,aged(41 ± 8)years] ,and 80 healthy adults served as control group.The clinical data of patients were collected ,and CAVS valve and normal valve were observed by HE staining.Expression feature of macrophages was studied by immunohistochemical(IHC)staining.IPP(Image‐Pro Plus)software was used to measure the densi‐ty of macrophages ,and Pearson relation analysis was employed to study the correlation between the density of macrophages and the degree of valve stenosis.Results As compared with healthy adults ,cholesterol and C reactive protein in patients with CAVS were significantly elevated.There were infiltration of inflammatory cells ,new blood capillaries and calcification in the valves of CAVS lesions observed by HE staining.No positive expression of macrophage marker CD68 was found in normal aortic valves , but CD68 positive expression was observed in the valves of CAVS by IHC staining ,and mainly concentrated in the peripheral calcification and osteoid tissues.Simple linear regression analysis showed the density of macrophages was positively correlated with the large pressure gradient(r=0.75 ,P<0.05) ,the average differential pressure(r=0.75 ,P<0.05) ,and the maximum aortic jet velocity(r=0.72 ,P<0.05) ,however ,was negatively correlated(r= -0.71 ,P<0.05)with the valve orifice area .Con‐clusion Compared with healthy adult volunteers ,the concentration of cholesterol and C reactive protein were elevated in blood of the patients with CAVS.Compared with the normal valve ,the macrophages were infiltrated in CAVS valves ;the density of macrophage was positively correlated with the degree of CAVS.
RESUMO
We report a case of a 79-year-old woman who underwent apicoaortic conduit bypass (ACB) surgery for severe calcific aortic valve stenosis. We did not perform conventional aortic valve replacement because of the patient's advanced age and because she had a small aortic annulus (17 mm) and a high risk of bleeding and cerebral infarction. ACB surgery through a left thoracotomy was performed via a femorofemoral bypass. A hand-made valve conduit was made from the left ventricular apex to the descending aorta. Her postoperative course was uneventful ; postoperative echocardiography showed a decreased pressure gradient at the native aortic valve between the left ventricle and the aorta. This procedure is useful in high-risk patients with severe calcified aortic valve stenosis.