Echocardiographic observations of calcium in operatively excised stenotic aortic valves

Qualitative and quantitative 2-dimensional (2-D) echocardiographic methods were developed to define the anatomic and physiologic significance of valvular calcium in aortic stenosis (AS). Qualitative methods assigned etiologic diagnoses by matching patterns of calcium with anatomic criteria. Quantitative techniques measured echodensities from superimposed short-axis views of calcium. Fifty-five pathologic specimens procured from surgery were photographed and radiographed. Etiologic diagnoses were assigned from gross examination and radiodensities were planimetered. Echocardiographic and anatomic diagnoses were compared. Sensitivities for diagnosing the most common etiologies, congenitally bicuspid and degenerative, were 58% and 100% and specificities were 100% and 76%. Calcium tended to be heaviest in congenitally diseased valves and lightest in those with degenerative disease (p less than 0.2) and showed propensity for the right cusp in all etiologies except for those with degenerative disease. Correlation of echodensities to radiodensities was 0.82. The relation of calcific echodensities to orifice area was curvilinear; beyond a level of calcium, further deposits did not reduce the orifice more. A systematic echocardiographic examination of calcium in stenotic aortic valves can give a correct etiologic diagnosis in most patients and identify the severely narrowed orifice.