Kathryn Statham , Genevieve Carbonatto
Valve destruction and degeneration
- infective endocarditis
- rheumatic heart disease
- aortic valve prolapse.
1. Valve sclerosis / stenosis
2 -3 % of people will develop severe AS after the age of 75. If the leaflets become thick and calcified they are poorly mobile causing them to close incompletely in diastole leading to AR
Severe aortic stenosis due to calcification of the aortic valve is the most common indication for aortic valve replacement in the US and Europe
The following 2 videos show aortic valve stenosis with moderate regurgitation
2. Infective endocarditis
Infective endocarditis causes valve destruction. The vegetations can be pedunculated or sessile. In the clips below, the vegetation is pedunculated and can be seen to flop back into the LV in diastole. This patient presented with acute , severe ART and pulmonary edema. Vegetations can also cause aortic cusp rupture leading to severe catastrophic AR
3. Rheumatic fever
Rheumatic heart disease causes valve deformity as a result of scarring
Leaflets thicken and retract. Commissures fuse, chords thicken and shorten and even fuse causing a “fish mouth” or “buttonhole” appearance. Subsequently the valve may calcify into a rigid structure. The mitral valve is always involved.
The calcification of aortic stenosis with rheumatic heart disease is different from that of degenerative calcified aortic stenosis. Calcification starts at the contact margins of the leaflets rather than the base.
4. Aortic valve prolapse
Aortic valve prolapse can occur with bacterial endocarditis but also with cusp fibrosis and calcification in patients with bicuspid valve disease as in this patient with severe aortic regurgitation.