同: 大動脈弁, AV

WordNet

control consisting of a mechanical device for controlling the flow of a fluid
device in a brass wind instrument for varying the length of the air column to alter the pitch of a tone
one of the paired hinged shells of certain molluscs and of brachiopods
the entire one-piece shell of a snail and certain other molluscs
a structure in a hollow organ (like the heart) with a flap to insure one-way flow of fluid through it
(of brass instruments) having valves

PrepTutorEJDIC

(液体・ガスなどの流れを調節する)『バルブ』,弁 / (血液の流れを調節する)弁,弁膜 / (管楽器の)バルブ / (2枚貝の)から,貝がら / 《英》真空管

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/13 04:09:03」(JST)

wiki en

The aortic valve is one of the two semilunar valves of the heart, the other being the pulmonary valve. The heart has four valves and the other two are the mitral and the tricuspid valves. The aortic valve normally has three cusps or leaflets, although in 1–2% of the population it is found to congenitally have two leaflets.^[1] It lies between the left ventricle and the aorta.

Structure

The aortic valve normally has three cusps – a left, right and posterior cusp.^[2]

Function

Video clip from the aortic valve in a living, beating pig heart.

During ventricular systole, pressure rises in the left ventricle. When the pressure in the left ventricle rises above the pressure in the aorta, the aortic valve opens, allowing blood to exit the left ventricle into the aorta. When ventricular systole ends, pressure in the left ventricle rapidly drops. When the pressure in the left ventricle decreases, the aortic pressure forces the aortic valve to close. The closure of the aortic valve contributes the A₂ component of the second heart sound (S₂).

Clinical significance

Micrograph demonstrating thickening of the spongiosa layer (blue) in myxomatous degeneration of the aortic valve.

There are two prototypical processes that can affect the aortic valve – aortic stenosis in which the valve fails to open fully, thereby obstructing blood flow out from the heart, and aortic insufficiency, also called aortic regurgitation, in which the aortic valve is incompetent and blood flows passively back to the heart in the wrong direction. These two conditions frequently co-exist. Common causes of aortic regurgitation include vasodilation of the aorta, previous rheumatic fever, infection, i.e. infective endocarditis, degeneration of the aortic valve, and Marfan's syndrome.

The most common congenital abnormality of the heart is the bicuspid aortic valve. In this condition, instead of three cusps, the aortic valve has two cusps. This condition is often undiagnosed until later in life when the person develops symptomatic aortic stenosis. Aortic stenosis occurs in this condition usually in patients in their 40s or 50s, an average of 10 years earlier than can occur in people with normal aortic valves. Aortic stenosis can also be caused by rheumatic fever and degenerative calcification.^[3]

Turner syndrome, a congenital condition that affects females, can often have a bicuspid aortic valve as one of its symptoms.

Aortic valve repair

Aortic valve repair or aortic valve reconstruction describes the reconstruction of both form and function of the native and dysfunctioning aortic valve. Most frequently it is applied for the treatment of aortic regurgitation. It can also become necessary for the treatment of aortic aneurysm, less frequently for congenital aortic stenosis.^[4]

Aortic valve replacement

Aortic valve replacement is a surgical procedure in which a patient's aortic valve is replaced by a different valve. The aortic valve can be affected by a range of diseases and require aortic valve replacement. The valve can become either leaky (regurgitant or insufficient) or stuck partially shut (stenotic). Aortic valve replacement traditionally required open heart surgery. A new alternative is transcatheter aortic valve replacement (TAVR), which delivers a mechanical valve to the site of the diseased valve through a catheter.^[5] There are two basic types of artificial heart valve, mechanical valves and tissue valves. Tissue heart valves are usually made from animal tissues, either animal heart valve tissue or animal pericardial tissue. The tissue is pretreated by removing antigens to prevent rejection and to prevent calcification.

There are alternatives to animal tissue valves. In some cases, a human aortic valve can be implanted. These are called homografts. Homograft valves are donated by patients and recovered after the patient expires. The durability of homograft valves is probably the same as for porcine tissue valves. Another procedure for aortic valve replacement is the Ross procedure (after Donald Ross) or pulmonary autograft. The Ross procedure involves going to surgery to have the aortic valve removed and replacing it with the patient's own pulmonary valve. A pulmonary homograft (a pulmonary valve taken from a cadaver) or a valvular prothesis is then used to replace the patient's own pulmonary valve.

The first minimally invasive aortic valve surgery took place at the Cleveland Clinic in 1996.

Another option for aortic valve replacement is transcatheter aortic valve replacement (TAVR). This procedure is for patients who are not candidates for surgery or who have high risk for surgery. This procedure can be done through the femoral artery, via direct aortic access, or via left ventricular apical access.

Additional images

Heart seen from above.
A replaceable model of Cardiac Biological Valve Prosthesis.
Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). Heart valves are labeled with "B", "T", "A", and "P".
Micrograph of a papillary fibroelastoma, a benign tumour seen on heart valves.
Apical view of valves
Aortic valves
Aortic valve

References

^ http://www.americanheart.org/presenter.jhtml?identifier=11068
^ Anatomy photo:20:29-0104 at the SUNY Downstate Medical Center – "Heart: The Aortic Valve and Aortic Sinuses"
^ Aortic Valve, Bicuspid at eMedicine
^ Hans-Joachim Schäfers: Current treatment of aortic regurgitation. UNI-MED Science, Bremen, London, Boston 2013, ISBN 978-3-8374-1406-6.
^ "What is TAVR?". American Heart Association. 2014. Retrieved 2015-08-15.

1. http://www.americanheart.org/presenter.jhtml?identifier=11068

External links

Anatomy figure: 20:07-02 at Human Anatomy Online, SUNY Downstate Medical Center

UpToDate Contents

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1. 成人における大動脈二尖弁の臨床症状および診断 clinical manifestations and diagnosis of bicuspid aortic valve in adults
2. 大動脈弁狭窄症における大動脈弁口面積 aortic valve area in aortic stenosis
3. 大動脈弁の心エコー評価 echocardiographic evaluation of the aortic valve
4. 成人における大動脈二尖弁疾患のマネージメント management of adults with bicuspid aortic valve disease
5. 成人の大動脈弁狭窄症における弁置換術の適応 indications for valve replacement in aortic stenosis in adults

English Journal

Imaging analysis of collagen fiber networks in cusps of porcine aortic valves: effect of their local distribution and alignment on valve functionality.

Mega M1, Marom G2, Halevi R1, Hamdan A3, Bluestein D2, Haj-Ali R1.
Computer methods in biomechanics and biomedical engineering.Comput Methods Biomech Biomed Engin.2016 Jul;19(9):1002-8. doi: 10.1080/10255842.2015.1088009. Epub 2015 Sep 25.
The cusps of native aortic valve (AV) are composed of collagen bundles embedded in soft tissue, creating a heterogenic tissue with asymmetric alignment in each cusp. This study compares native collagen fiber networks (CFNs) with a goal to better understand their influence on stress distribution and
PMID 26406926

The role of cardiac biochemical markers in aortic stenosis.

Chin CW1,2, Djohan AH3, Lang CC4.
Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals.Biomarkers.2016 Jun;21(4):316-27. doi: 10.3109/1354750X.2016.1141993. Epub 2016 Feb 22.
Calcified aortic stenosis is one of the most common causes of heart failure in the elderly. Current guidelines recommend aortic valve replacement in patients with severe disease and evidence of decompensation based on either symptoms or impaired systolic ejection fraction. However, symptoms are ofte
PMID 26900722

The effect of statins therapy in aortic stenosis: Meta-analysis comparison data of RCTs and observationals.

Zhao Y1, Nicoll R2, He YH1, Henein MY2.
Data in brief.Data Brief.2016 Feb 26;7:357-61. doi: 10.1016/j.dib.2016.02.045. eCollection 2016.
Aortic stenosis has been shown to share the same risk factors as atherosclerosis which suggested a potential benefit from statins therapy. Fourteen studies which provided the effect of statins treatment on aortic stenosis (AS) were meta-analyzed, including 5 randomized controlled trials (RCTs) and 9
PMID 26977437

Japanese Journal

症例重症大動脈弁狭窄を併存した大腿骨頸部骨折に対する同時手術の1例

三澤吉雄,佐藤俊介,相澤啓,川人宏次,伊志嶺卓,竹下克志,高橋政夫,船山大,苅尾七臣
胸部外科 = The Japanese journal of thoracic surgery 72(3), 224-227, 2019-03
NAID 40021822627

臨床経験 Stanford A型急性大動脈解離を発症した大動脈二尖弁逆流に対する弁形成術

菊池悠太,菊池洋一,椎久哉良,熱田義顕
胸部外科 = The Japanese journal of thoracic surgery 72(3), 190-193, 2019-03
NAID 40021822483

Comparison between valve-sparing root replacement and Bentall procedure in patients with Marfan syndrome

Nakaji Shun,Miura Takashi,Takura Masayuki,Miyanaga Tatsuya,Taguchi Hiroko,Shimada Takashi,Tasaki Yuichi,Matsumaru Ichiro,Yokose Shogo,Obase Kikuko,Eishi Kiyoyuki
Acta medica Nagasakiensia 62(3), 95-100, 2019-03
… Background: Bentall procedure is standard procedure for aortic root aneurysm or dissection in patients with Marfan syndrome. … The purpose of this study was to evaluate whether valve-sparing root replacement (VSR) can be an alternative to Bentall procedure in patients with Marfan syndrome. … Methods: Thirteen patients with Marfan syndrome underwent aortic root replacement between 1999 and 2017. …
NAID 120006602379

Related Pictures

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リンク元	「大動脈弁」「AV」
拡張検索	「aortic valve stenosis」「aortic valve insufficiency」
関連記事	「aortic」「valve」

「大動脈弁」

Aortic valve
	Frontal view of the Aortic valve
	Aortic valve
Details
Identifiers
Latin	valva aortae
TA	A12.1.04.012
FMA	7236
	Anatomical terminology [edit on Wikidata]