Calcific valve disease
- Lesion
With age, calcium builds up on heart valves. A stiff aortic valve narrows the outflow; a bicuspid valve does this earlier.
What it is
Calcific aortic stenosis is the commonest valve disease in high-income countries. Years of mechanical stress and an atherosclerosis-like process (lipid, inflammation, and valve interstitial cells turning into bone-forming cells) deposit calcium on the aortic side of the cusps. Tricuspid valves are affected in the 70s and 80s; congenitally bicuspid valves, present in about 1 to 2 % of people, calcify earlier, in the 40s to 60s. Mitral annular calcification deposits calcium in the ring of the mitral valve, usually in older women, and rarely obstructs flow.
Structure
- Gross: rigid cusps with nodular calcified masses filling the sinuses of Valsalva.
- Microscopy: layered architecture of the cusp lost; calcification, sometimes with metaplastic bone; lipid and inflammatory cells in early lesions.
Calcific valve lesions compared
| Lesion | Who | Pathology | Effect |
|---|---|---|---|
| Senile calcific aortic stenosis | Older adults (70s–80s) | Heaped-up calcium in sinuses of a three-cusp valve; free edges spared | Outflow obstruction, LV hypertrophy |
| Calcific stenosis of a bicuspid valve | Younger adults (40s–60s) | Two cusps of unequal size, raphe, early calcification | Stenosis or regurgitation; aortic dilation |
| Mitral annular calcification | Older adults, mostly women | Calcium nodules in the fibrous mitral ring | Usually none; sometimes regurgitation, block, emboli |
Clinical notes
- The classic triad of severe aortic stenosis is angina, syncope and heart failure.
- Transcatheter valve implantation is now an option in many older patients.
Test yourself
Think of the answer, then tap the question to see it.
What distinguishes calcific (degenerative) aortic stenosis from rheumatic aortic stenosis?
In calcific stenosis the commissures are not fused; in rheumatic disease commissural fusion is typical and the mitral valve is almost always involved.
Why does a bicuspid aortic valve become stenotic earlier?
The abnormal cusp geometry increases mechanical stress, so calcification develops decades earlier.
What is the classic symptom triad of severe aortic stenosis?
Angina, syncope and heart failure.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Aortic stenosis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.