[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Heart](https://durgical.com/en/general-pathology/areas/heart/) › Calcific valve disease

# 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.

Updated Nov 12, 2026

## Key points

- Calcified masses in the cusp sinuses on the outflow side; no commissural fusion, unlike rheumatic aortic stenosis.
- Pressure overload: concentric LV hypertrophy; symptoms (angina, syncope, heart failure) mean a poor prognosis without valve replacement.
- Bicuspid aortic valve: one cusp has a raphe; linked to NOTCH1 mutations, Turner syndrome and dilation of the ascending aorta.
- Mitral annular calcification: rarely affects function, but can cause regurgitation, conduction block, emboli and a site for endocarditis.
- Lipoprotein(a) is a risk factor for calcific aortic stenosis.

## 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](https://durgical.com/en/conditions/aortic-valve-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](https://durgical.com/en/conditions/aortic-valve-stenosis/) | 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.

## Memory aid

Wear and tear turns the aortic cusps to stone: at 80 with three cusps, at 50 with two.

## 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.

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## Elsewhere in DurgiPedia

- [The heart wall, valves and conduction tissue](https://durgical.com/en/histology/the-heart-wall-valves-and-conduction-tissue/)
- [Valve murmurs: the table to know](https://durgical.com/en/clinical-exam/valve-murmurs-the-table-to-know/)

## Connections

## Related 4

- [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/)
- [Valve disease: causes by valve](https://durgical.com/en/general-pathology/valve-disease-causes-by-valve/)
- [Heart failure: hypertrophy and remodelling](https://durgical.com/en/general-pathology/heart-failure-hypertrophy-and-remodelling/)
- [Aortic dissection](https://durgical.com/en/general-pathology/aortic-dissection/)

## Related conditions 5

- [Aortic Valve Stenosis](https://durgical.com/en/conditions/aortic-valve-stenosis/)
- [Mitral regurgitation](https://durgical.com/en/conditions/mitral-regurgitation/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Turner syndrome](https://durgical.com/en/conditions/turner-syndrome/)
- [Coarctation of the aorta](https://durgical.com/en/conditions/coarctation-of-the-aorta/)

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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](https://medlineplus.gov/ency/article/000178.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/calcific-valve-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/calcific-valve-disease/