A man aged 83 with a history of shortness of breath for the past 18 months was admitted to hospital following several blackouts. Clinical examination revealed a cyanosed, dyspnoeic man, with a pulse rate of 94, blood pressure of 120/100 mm Hg, raised jugular venous pressure, an apex beat in the axilla and a to-and-fro murmur maximal in the 3rd inter-costal space at the left sternal border. Bilateral crepitations and pitting oedema were present. The patient died following admission.
The specimen is a dissected aortic valve mounted to display the superior surface. The valve cusps are fused and considerably thickened by irregular nodules of calcified material. A thin slit between two cusps allows communication between the left ventricle and the ascending aorta. A fenestration 0.5 cm in diameter is present in the cusp on the lower left of the specimen. This is an example of aortic stenosis.
The majority of cases of aortic stenosis in this country are due to calcific aortic stenosis which is usually diagnosed in old age. This lesion commonly occurs in a congenitally bicuspid aortic valve, and this specimen may have been an example of that. However, calcific aortic stenosis may also occur in a previously normal valve, in which case the cusps are thickened, rigid and nodular, but usually not fused. A minority of cases of aortic stenosis are due to chronic rheumatic carditis, but if the lesion is rheumatic in origin, there is likely to be mitral valve disease as well. A few cases of aortic stenosis are congenital in origin, and sometimes the cause cannot be determined.