![](https://d3hj8eczelsk9p.cloudfront.net/wp-content/uploads/2020/03/17103800/title-image-e1584401926652.png)
Kathryn Statham
Aortic stenosis
- It is the most common valvular heart disease in developed countries
- It’s prevalence is increasing with our ageing population
- It is found in 3% of patients > 75 yrs
- It is the most common valve disease requiring surgical intervention in developed countries. TAVI is increasingly the treatment of choice for severe AS
- Aortic sclerosis is a precursor of aortic stenosis and present in 25% of patients > 65 yrs
Causes
- Congenital (unicuspid and bicuspid)
- Acquired (calcific and rheumatic)
Aortic stenosis aetiology: Morphology of calcific AS, bicuspid valve and rheumatic AS (adapted from C Otto Practice of clinical echocardiography 2007 )
1.Congenital
Please also refer to the previous post : https://www.criticalcare-sonography.com/2020/02/20/3-causes-of-aortic-regurgitation-congenitally-abnormal-valves/
Unicuspid aortic valve
- One solitary opening and one point attachment to the aorta
- Very rare
- Typically stenotic at birth
Bicuspid valve
- Most common cardiac congenital abnormality
- Most common cause of isolated AS in patients under 50
- Accelerated calcification is common with premature stenosis
- The bicuspid valve can either be a “true ” bicuspid valve (BAV) (2 commissures) or a BAV with a “raphe”
“
True” bicuspid aortic valve (no raphe)
Bicuspid valve with Raphe (arrow)
Calcified Bicuspid Valve
Features on ECHO which may indicate a bicuspid valve
- Eccentric flow and/or eccentric regurgitation
- Aortic dilatation (BAV is associated with aortopathies)
- Abnormal thickening of the valve leaflets in a young person
- Systolic doming or “skipping rope” appearance from PLAX view
- Eccentric closure on M-mode
- LVH without a history of hypertension
- Eccentric AR seen from apical 5 chamber view
2. Eccentric leaflet closure on M mode
Closure in normal AV below
3. Systolic doming or “skipping rope” appearance from PLAX view
![](https://d3hj8eczelsk9p.cloudfront.net/wp-content/uploads/2020/03/10164922/bicuspid-valve-PLAX-300x253.jpg)
![](https://d3hj8eczelsk9p.cloudfront.net/wp-content/uploads/2020/03/10164936/BV-PSAX-300x231.jpg)
Systolic doming or “skipping” rope appearance of the leaflets
2.Acquired
In acquired aortic stenosis there are 3 leaflets and visible calcification with reduced leaflet excursion
a. Senile calcification
- deposition of calcium on trileaflet aortic valve
- most common type of aortic stenosis in western world
- generally occurs in 80s & 90s
- cusps are immobilized by calcium deposits
- may have concomitant mitral annular calcification or coronary artery disease
- commissural fusion is absent
Calcific aortic stenosis from PSAX view
Severe calcific aortic stenosis from PLAX view
b. Rheumatic heart disease
- Most commonly seen in developing countries
- Caused by acute episode of rheumatic fever
- There is less calcification & more commissural fusion
- Almost always accompanied by rheumatic mitral disease
- Often also results in aortic regurgitation due to poor leaflet coaptation
- Leaflets are thickened with focal calcification
Severe rheumatic aortic stenosis with visible coaptation defect
Rheumatic aortic valve. (note rheumatic mitral valve)
Severe rheumatic aortic stenosis (note rheumatic mitral valve)
References
- The practice of clinical echocardiography by Catherine Otto 5th edition Elsevier