Valve Ossification

This aortic valve was from an 86 year old woman with a history of hypertension, a systolic murmur, and documented aortic valve stenosis.  The valve cusps showed a large amount of dystrophic calcification and, as illustrated here, areas of ossification. The inset photo is a higher magnification of bone with marrow.

Dystrophic calcification is a common finding in aortic and mitral valves in the elderly and can lead to surgical replacement because of significant obstruction. In one large series of patients with a mean age of 68 (Mohler ER et al. Circulation 2001;103:1522) 83% showed dystrophic calcification in excised aortic and mitral valves. 15% contained mature lamellar bone with hematopoietic elements, as in this case. The presence of bone matrix proteins was shown in the study. In addition to depositions in the aortic and mitral valve cusps and leaflets, dystrophic calcification can involve the mitral annulus, sometimes extending into the cardiac skeleton causing conduction disturbances. Dystrophic calcification often occurs in valves deformed by rheumatic fever or in congenitally bicuspid aortic valves but most commonly aortic valve stenosis due to dystrophic calcification in the elderly has no such underlying valve deformity. Ectopic ossification has also been reported in the myocardium (Grossman CM. J Trauma 1974;14:85).

Contributed by Dr. Shahrzad Ehdaivand.