Author + information
- Received August 24, 1989
- Revision received November 1, 1989
- Accepted November 22, 1989
- Published online April 1, 1990.
- Jeffrey M. Isner, MD, FACC∗,
- Saurabh K. Chokshi, MD, FACC,
- Anthony Defranco, MD,
- John Braimen, MD and
- Geralyn A. Slovenkai, BS
- ↵∗Address for reprints: Jeffrey M. Isner, MD, St. Elizabeth's Hospital, 736 Cambridge Street, Boston, Massachusetts 02135.
Preliminary findings from clinical trials of percutaneous balloon aortic valvuloplasty and intraoperative debridement of calcific deposits in patients with aortic stenosis have suggested that calcified, congenitally bicuspid aortic valves may be less amenable to these techniques than are calcified tricuspid aortic valves. Accordingly, we evaluated the histoarchitecture of calcific deposits in 30 operatively excised aortic valves. Light microscopic sections taken through the calcified aortic valve leaflets disclosed two principal types of histoarchitectitre. In 11 aortic valves nodular calcific deposits were superimposed on an underlying fibrotic aortic valve leaflet (type A); in 17 valves calcific deposits were diffusely distributed throughout the body (spongiosa) of the aortic valve leaflets (type B). Two aortic valves could not be classified histologically.
These histologic subtypes were not randomly distributed with regard to gross valvular morphology. All 14 bicuspid valves (100%) were type B; in contrast, 11 (69%) of 16 tricuspld aortic valves were type A, and only 3 (19%) of 16 tricuspid valves were type B (p < 0.01). Both valves with nonclassifiable histologic features were tricuspid on the basis of gross examination.
Thus, the histoarchitectural distribution of calcific deposits is different for bicuspid than for tricuspid stenotic aortic valves. The more diffuse distribution of calcium throughout the body of calcified bicuspid aortic valve leaflets may render these valves less amenable to operative and percutaneous valvuloplasty than are calcified tricuspid aortic valve leaflets on which calcific deposits are typically superimposed in nodular form.
☆ This study was supported in part by Grants HL32747 and HL40518 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; the Eleanor Naylor Dana Foundation, New York, New York; and the John and Cora Davis Foundation, Washington, D.C. This work was presented in part at the 37th Annual Scientific Session of the American College of Cardiology, Atlanta, Geoigia, March 1988.
- Received August 24, 1989.
- Revision received November 1, 1989.
- Accepted November 22, 1989.