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(Circulation. 2005;111:3316-3326.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Spectrum of Calcific Aortic Valve Disease

Pathogenesis, Disease Progression, and Treatment Strategies

Rosario V. Freeman, MD, MS; Catherine M. Otto, MD

From the Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash.

Correspondence to Rosario V. Freeman, MD, MS, Division of Cardiology, Box 356422, University of Washington, Seattle, WA 98195-6422. E-mail rosariof@u.washington.edu

Received October 26, 2004; revision received January 13, 2005; accepted February 4, 2005.

Key Words: aortic stenosis • aortic sclerosis • risk factors • valves • inflammation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Calcific aortic valve disease is a slowly progressive disorder with a disease continuum that ranges from mild valve thickening without obstruction of blood flow, termed aortic sclerosis, to severe calcification with impaired leaflet motion, or aortic stenosis (Figure 1). In the past, this process was thought to be "degenerative" because of time-dependent wear-and-tear of the leaflets with passive calcium deposition. Now, there is compelling histopathologic and clinical data suggesting that calcific valve disease is an active disease process akin to atherosclerosis with lipoprotein deposition, chronic inflammation, and active leaflet calcification. The overlap in the clinical factors associated with calcific valve disease and atherosclerosis and the correlation between the severity of coronary artery and aortic valve calcification provide further support for a shared disease process.

View larger version (89K): [in this window] [in a new window]   Figure 1. Gross specimen of minimally diseased aortic valve (left) and severely stenotic aortic valve (right). In the severely stenotic valve, there are prominent lipocalcific changes on aortic side of valve cusps (arrow), with sparing of commissures.

	Pathogenesis of Calcific Aortic Valve Disease

 
Anatomy of Normal Aortic Valve
The normal aortic valve comprises 3 layers. The ventricularis, on the ventricular side of the leaflet, is composed of elastin-rich fibers that are aligned in a radial direction, perpendicular to the leaflet margin. The fibrosa, on the aortic side of the leaflet, comprises primarily fibroblasts and collagen fibers arranged circumferentially, parallel to the leaflet margin. The spongiosa is a layer of loose connective tissue at the base of the leaflet, between the fibrosa and ventricularis, composed of fibroblasts, mesenchymal cells, and a mucopolysaccharide-rich matrix. These layers work . . . [Full Text of this Article]

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