Morphological and clinical findings in 247 surgically excised native aortic valves

Aortic valve disease is an increasingly common medical problem in the 20th century; however, its pathogenesis is poorly understood. The present paper reviews 247 cases of aortic valves surgically excised over a one-year period, with special attention to the morphological and histological changes observed in surgically excised aortic valves, and to how those changes relate to the mechanisms of valve failure. Patient age ranged from 17 to 86 years, with a mean of 64.1 +/-13.4 years, and there were 156 men (63.2%) and 91 women (36.8%). A total of 172 valves (69.6%) were tricuspid and 75 valves (30.4%) were congenitally abnormal, of which 67 valves (27.1%) were congenitally bicuspid, six valves (2.4%) were congenitally unicommissural and one valve (0.4%) was quadricuspid; the status of one valve could not be determined. Almost 70% of patients had features of aortic stenosis. Calcification was seen in the large majority of cases, with almost 70% of the valves showing either grade 3 or grade 4 calcification. Ulceration of calcific nodules was present in 42.0% of cases and in the majority of the valves with grade 4 calcification. A total of 15% of the valves showed evidence of postinflammatory changes consistent with rheumatic disease. Neovascularization was present in two-thirds of all valves, while one-half showed inflammatory cell infiltrates. Inflammatory cells were composed mainly of lymphocytes and macrophages, and were located primarily near areas of neovascularization. There was no significant difference in the pathological findings between men and women.