Description

The aortic valve may show calcifications, especially in the elderly. The severity of the calcification can be graded based on its gross and microscopic appearance.


 

Grade 1:

(1) Structure of valve: The structural integrity of the valve is retained. Mild fibrous thickening may be seen on the side of the sinus of Valsalva.

(2) Fibrosa and elastic tissue: intact

(3) Calcifications: none

 

Grade 2:

(1) Structure of valve: There is obvious thickening of the valve cusp.

(2) Fibrosa and elastic tissue: The fibrosa is slightly distorted but the elastic tissue is intact.

(3) Calcifications: There is early development of calcified nodules at the site of connective tissue degeneration, initially on the sinus of Valsalva side of the cusp.

 

Grade 3:

(1) Structure of valve: The valve cusp is grossly thickened and distorted.

(2) Fibrosa and elastic tissue: The fibrosa is distorted and the elastic tissue is stretched.

(3) Calcifications: Many calcified nodules present.

(4) Other findings: Cartilagenous and osseous metaplasia; cholesterol crystal deposits; neovascularization.

 

Grade 4A: Ulceration absent on the surface of the cusp.

(1) Structure of valve: The valve cusp is grossly distorted with most of the ordinary structural components altered, degenerated or destroyed.

(2) Fibrosa and elastic tissue: The fibrosa and elastic fibers are disrupted.

(3) Calcifications: Many calcified nodules present.

(4) Other findings: Cartilagenous and osseous metaplasia; cholesterol crystal deposits; neovascularization.

 

Grade 4B: Ulceration present on the surface of the cusp.

(1) Structure of valve: The valve cusp is grossly distorted with most of the ordinary structural components altered, degenerated or destroyed.

(2) Fibrosa and elastic tissue: The fibrosa and elastic fibers are disrupted.

(3) Calcifications: Many calcified nodules present.

(4) Other findings: Cartilagenous and osseous metaplasia; cholesterol crystal deposits; neovascularization.

 


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