Physicochemical and micro-tomographic characterization of inorganic deposits associated with aortic stenosis

A major feature of aortic stenosis is massive mineralization of the aortic valve, though the mechanism of the process remains unclear. The study aim was to characterize the chemical composition and morphology of inorganic deposits from surgically excised natural aortic valves and to seek similarities to minerals in bones and teeth.

Mineral deposits from 30 surgically excised natural aortic valves were examined. The control group consisted of autopsy samples (aortic valves, vertebral bodies) and teeth obtained after extraction. Micro-computed tomography (micro-CT) was used to describe the morphology and density of the minerals. X-ray fluorescence and Fourier transform infrared spectroscopy were applied to determine the chemical composition.

A poorly crystalline, B-type carbonate-containing hydroxyapatite (HAP) was found to constitute the mineral phase of the aortic valve leaflets. No other chemical compounds were identified. The elemental composition of the minerals in aortic valves and bone/tooth did not differ markedly, except that the Mg concentration was fourfold higher in valve material. The aortic valve deposits were irregular in shape and occupied ca. 40% of the leaflet volume. The volume of the deposits were spread over a broad range (0.001-0.3 mm3), while the density ranged from that of dentine to enamel (average value 2.2 g/cm3), slightly higher than that of compact bone.

The aortic valve deposits were identified as B-type carbonate-containing HAP, and were not identical to those found in bones and teeth, the main difference being a fourfold elevated Mg content. Mg may have been deposited as a separate compound, as micro-CT results suggested that the formation of mineral deposits in aortic valves was a multi-factorial process. The morphological parameters and densities of the valve deposits were spread over a broad range (factor approximately 300). An unequivocal identification of the mechanism responsible for the aortic valve pathological calcification was not possible, however.