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[Nonrheumatic calcification of the mitral valve in patients with stenotic calcified bicuspid aortic valve]
H Sawada1, M Shionoya, Y Shibata
1Cardiovascular Institute, Tokyo.
Insights
Nonrheumatic mitral valve calcification in patients with bicuspid aortic valves appears to stem from the progression of aortic valve calcification. This finding offers new insights into valvular heart disease pathogenesis.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Echocardiography
Background:
- Nonrheumatic mitral valve calcification is a distinct clinical entity.
- Its pathogenesis remains incompletely understood, particularly in the context of bicuspid aortic valves.
Purpose of the Study:
- To investigate the clinical and echocardiographic features of nonrheumatic mitral valve calcification.
- To identify potential underlying causes and associated factors.
Main Methods:
- Analysis of clinical and echocardiographic data from nine patients with mitral valvular calcification.
- Exclusion of rheumatic heart disease and infective endocarditis.
Main Results:
- All nine patients had calcified, stenotic bicuspid aortic valves.
- Mitral valve calcification was localized to the anterior mitral leaflet, contiguous to the aortic valve.
- No association found with atherosclerosis risk factors, mechanical stress, or mitral annular calcification.
Conclusions:
- Mitral valve calcification in this cohort likely results from the progression of calcification from the bicuspid aortic valve.
- Rheumatic disease, atherosclerosis, and mechanical factors do not appear to be primary drivers.
Abstract:
The pathogenesis of nonrheumatic calcification of the mitral valve was investigated by analyzing the clinical and echocardiographic characteristics of patients with mitral valvular calcification without any findings suggestive of rheumatic heart disease or infective endocarditis. Calcification of the mitral valve was observed in nine patients, who all had calcified stenotic (aortic valve area < 1 cm2) bicuspid aortic valve. Calcification of the mitral valve was localized to the basal portion of ventricular aspect of the anterior mitral leaflet and contiguous to that of the aortic valve. Mobility and thickness of the mitral leaflet was normal except for the calcified portion. Calcification of the mitral valve was not contiguous to posterior mitral annular calcification nor was related to direction of aortic regurgitant flow. In patients with calcified stenotic bicuspid aortic valve, calcification of the mitral valve was not associated with location of the two aortic cusps, aortic valve area, aortic valvular peak pressure gradient, direction of the left ventricular outflow, end-diastolic left ventricular outflow tract dimension, end-diastolic dimension of the aortic annulus, incidence of aortic regurgitation, calcification of the aortic arch, or risk factors of atherosclerosis. Six patients with mitral valvular calcification had aortic valve replacement. Preoperative coronary angiogram of these patients was normal. Calcification of the aortic valve was on the ventricular and aortic aspects. The calcification of the aortic valve, anterior mitral ring, or anterior mitral leaflet was not rheumatic in these six patients. Rheumatic disease, risk factors of atherosclerosis, mechanical stress by left ventricular outflow or aortic regurgitant flow, or mitral annular calcification did not appear to be related to mitral valvular calcification. The distribution of aortic and mitral valvular calcification suggested that the calcification of the mitral valve was due to progression of calcification of the bicuspid aortic valve.