Sheldon Singh, BSc
Valvular heart disease is an increasingly common cause of congestive heart failure in the elderly population. Stenosis of the aortic valve is one type of valvular heart disease that can lead to congestive heart failure. Approximately 28,000 aortic valve replacements were performed in the United States in 1994. Sixty-one per cent of these were performed in individuals over age 65. This procedure is the second most common open-heart procedure performed in the elderly after coronary bypass grafting.
In adults, aortic stenosis may be due to previous rheumatic disease or calcification of a congenital bicuspid valve or normal tricuspid aortic valve. Although common worldwide, rheumatic disease is uncommon in North America and Europe. However, because of the increasing aging population, degenerative aortic valve calcification constitutes a substantial health problem.1
Anatomy
A normal aortic valve is tricuspid. Each leaflet is flexible and composed of three layers covered with endothelium on each side. Degenerative calcific disease is characterized by discrete focal lesions on the aortic side of the leaflet. It is typically an active inflammatory process that bears some resemblance to atherosclerosis; there are protein and lipid infiltration as well as macrophages, foam cells, and the occasional T cell.2 The risk factors for aortic valve disease include age, male gender, lipoprotein a, hypertension, smoking, cholesterol and diabetes.
