Calcified Aortic Valvular Stenosis Bicuspid Aortic Valve - Erler Zimmer

Calcified Aortic Valvular Stenosis Bicuspid Aortic Valve - Erler Zimmer

Clinical History

There is no clinical history provided for this specimen.

Pathology

The specimen consists of a partial horizontal 1.5cm slice through the plane of the left atrium, revealing the smooth internal lining of the left auricular appendage and part of the left ventricle on the inferior aspect. On the superior aspect, the pulmonary trunk (and part of the pulmonary tricuspid valve) and aorta, including the affected abnormal bicuspid valve, are clearly visible. From this upper perspective, calcified aggregations or thickenings on the opposing margins of the valve can be observed, along with a region of calcification on one of the cusps of the pulmonary valves.

Further Information

Bicuspid aortic valve is a prevalent congenital anomaly often undetected until adulthood and represents the most common congenital heart abnormality. Aortic valve stenosis, ranging from mild to severe, typically manifests signs and symptoms when the valve narrowing becomes severe. Some individuals may remain asymptomatic for an extended period. Symptoms may include abnormal heart sounds (heart murmur), radiating chest pain (angina), shortness of breath and chest pain, especially during increased activity, and heart palpitations—sensations of a rapid, fluttering heartbeat. Aortic valve stenosis can lead to heart failure, characterized by fatigue, shortness of breath, and swelling in the ankles and feet.

As the aortic valve narrows, the left ventricle exerts increased effort to pump blood into the aorta and the rest of the body. This heightened workload may cause thickening and enlargement of the left ventricle. Eventually, the additional strain can weaken the left ventricle and the heart overall, leading to impaired function (heart failure) and subsequent complications.

Calcium deposits accumulate on the valve, particularly in individuals with a congenitally abnormal aortic valve like a bicuspid aortic valve, resulting in stiffening of the valve cusps. This stiffening narrows the aortic valve lumen, leading to increased blood flow.