Skip to main content
SpringerLink
Log in

Valve Calcification (Aortic and Mitral)

  • Chapter
  • First Online:
Cardiovascular Calcification

  • 829 Accesses

Abstract

Cardiac valve calcification (CVC) is characterised by slowly progressive fibro-calcific remodelling of valve leaflets in calcific aortic valve disease or the mitral annulus in mitral annular calcification (MAC). Calcific aortic valve disease is the most prevalent cause of aortic stenosis worldwide and poses a significant disease burden being the third most common cardiovascular problem after coronary artery disease and hypertension. Although MAC has a higher disease prevalence, calcific aortic valve disease is associated with significant morbidity and has important clinical implications. Risk factors of CVC are generally similar to those of atherosclerosis; hypertension, diabetes mellitus and hypercholesterolemia. Historically presumed to be caused by a degenerative process, there is now emerging histopathological and clinical evidence to suggest that the pathophysiology of CVC is an active and multifaceted process that involves chronic inflammation, lipoprotein deposition, extracellular matrix remodelling and osteoblastic transformation of valvular cells. Doppler echocardiography is the principal investigative modality in diagnosing cardiac valve disease, complemented by multi-slice computed tomography (MSCT) and cardiac magnetic resonance imaging (MRI) to quantitate calcification which serves as a surrogate marker of disease severity. To date, there remains no effective pharmacotherapy to delay or halt disease progression and management involves surgical valve replacement or minimally invasive alternatives such as transcatheter aortic/mitral valve insertion in symptomatic patients. The heart valve team plays a crucial role in deciding which patients will benefit most from an intervention by taking into account patient symptoms, cardiac function, coexisting medical conditions and their functional baseline.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vaslef SN, Roberts WC. Early descriptions of aortic valve stenosis. Am Heart J. 1993 May;125(5 Pt 1):1465–74.

    Article  CAS  Google Scholar 

  2. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013 Jan 1;127(1):143–52.

    Article  Google Scholar 

  3. Coffey S, Cox B, Williams MJ. The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2852–61.

    Google Scholar 

  4. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16;368(9540):1005–11.

    Article  Google Scholar 

  5. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005 Feb 22;111(7):920–5.

    Article  Google Scholar 

  6. Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nat Rev Dis Primers. 2016 Mar 3;2:16006.

    Article  Google Scholar 

  7. Boon A, Cheriex E, Lodder J, Kessels F. Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus or aortic valve. Heart. 1997 Nov;78(5):472–4.

    Article  CAS  Google Scholar 

  8. Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation. 2006 Feb 14;113(6):861–6.

    Article  Google Scholar 

  9. Fox CS, Vasan RS, Parise H, Levy D, O’Donnell CJ, D’Agostino RB, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation. 2003 Mar 25;107(11):1492–6.

    Article  Google Scholar 

  10. Correia J, Rodrigues D, da Silva AM, Sáe Melo A, Providência LA. Massive calcification of the mitral valve annulus in an adolescent with Marfan syndrome. A case report. Rev Port Cardiol. 2006 Oct;25(10):921–6.

    Google Scholar 

  11. Schieken RM, Kerber RE, Ionasescu VV, Zellweger H. Cardiac manifestations of the mucopolysaccharidoses. Circulation. 1975 Oct;52(4):700–5.

    Article  CAS  Google Scholar 

  12. Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Streather CP, et al. Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis. 2007 Apr;191(2):348–54.

    Article  CAS  Google Scholar 

  13. Schoen FJ. Evolving concepts of cardiac valve dynamics: the continuum of development, functional structure, pathobiology, and tissue engineering. Circulation. 2008 Oct 28;118(18):1864–80.

    Article  Google Scholar 

  14. Chen JH, Simmons CA. Cell-matrix interactions in the pathobiology of calcific aortic valve disease: critical roles for matricellular, matricrine, and matrix mechanics cues. Circ Res. 2011 Jun 10;108(12):1510–24.

    Article  CAS  Google Scholar 

  15. Rajamannan NM, Evans FJ, Aikawa E, Grande-Allen KJ, Demer LL, Heistad DD, et al. Calcific aortic valve disease: not simply a degenerative process: A review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: Calcific aortic valve disease-2011 update. Circulation. 2011 Oct 18;124(16):1783–91.

    Article  Google Scholar 

  16. Leopold JA. Cellular mechanisms of aortic valve calcification. Circ Cardiovasc Interv. 2012 Aug 1;5(4):605–14.

    Article  Google Scholar 

  17. Kaden JJ, Dempfle CE, Grobholz R, Fischer CS, Vocke DC, Kiliç R, et al. Inflammatory regulation of extracellular matrix remodeling in calcific aortic valve stenosis. Cardiovasc Pathol. 2005 Mar-Apr;14(2):80–7.

    Article  CAS  Google Scholar 

  18. Wylie-Sears J, Aikawa E, Levine RA, Yang JH, Bischoff J. Mitral valve endothelial cells with osteogenic differentiation potential. Arterioscler Thromb Vasc Biol. 2011 Mar;31(3):598–607.

    Article  CAS  Google Scholar 

  19. Combs MD, Yutzey KE. Heart valve development: regulatory networks in development and disease. Circ Res. 2009 Aug 28;105(5):408–21.

    Article  CAS  Google Scholar 

  20. Piera-Velazquez S, Li Z, Jimenez SA. Role of endothelial-mesenchymal transition (EndoMT) in the pathogenesis of fibrotic disorders. Am J Pathol. 2011;179:1074–80.

    Article  CAS  Google Scholar 

  21. Yao Y, Bennett BJ, Wang X, Rosenfeld ME, Giachelli C, Lusis AJ, et al. Inhibition of bone morphogenetic proteins protects against atherosclerosis and vascular calcification. Circ Res. 2010 Aug 20;107(4):485–94.

    Article  CAS  Google Scholar 

  22. Jahnen-Dechent W, Heiss A, Schäfer C, Ketteler M. Fetuin-A regulation of calcified matrix metabolism. Circ Res. 2011 Jun 10;108(12):1494–509.

    Article  CAS  Google Scholar 

  23. Koos R, Krueger T, Westenfeld R, Kühl HP, Brandenburg V, Mahnken AH, et al. Relation of circulating Matrix Gla-Protein and anticoagulation status in patients with aortic valve calcification. Thromb Haemost. 2009 Apr;101(4):706–13.

    Article  CAS  Google Scholar 

  24. Lerner RG, Aronow WS, Sekhri A, Palaniswamy C, Ahn C, Singh T, et al. Warfarin use and the risk of valvular calcification. J Thromb Haemost. 2009 Dec;7(12):2023–7.

    Article  CAS  Google Scholar 

  25. Boström KI, Rajamannan NM, Towler DA. The regulation of valvular and vascular sclerosis by osteogenic morphogens. Circ Res. 2011 Aug 19;109(5):564–77.

    Article  Google Scholar 

  26. Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res. 2006 Nov 10;99(10):1044–59.

    Article  CAS  Google Scholar 

  27. Hajdu Z, Romeo SJ, Fleming PA, Markwald RR, Visconti RP, Drake CJ. Recruitment of bone marrow-derived valve interstitial cells is a normal homeostatic process. J Mol Cell Cardiol. 2011 Dec;51(6):955–65.

    Article  CAS  Google Scholar 

  28. Chen JH, Yip CY, Sone ED, Simmons CA. Identification and characterization of aortic valve mesenchymal progenitor cells with robust osteogenic calcification potential. Am J Pathol. 2009 Mar;174(3):1109–19.

    Article  CAS  Google Scholar 

  29. Leskelä HV, Satta J, Oiva J, Eriksen H, Juha R, Korkiamäki P, et al. Calcification and cellularity in human aortic heart valve tissue determine the differentiation of bone-marrow-derived cells. J Mol Cell Cardiol. 2006 Oct;41(4):642–9.

    Article  Google Scholar 

  30. Richardson MR, Yoder MC. Endothelial progenitor cells: quo vadis? J Mol Cell Cardiol. 2011 Feb;50(2):266–72.

    Article  CAS  Google Scholar 

  31. Davies MJ, Treasure T, Parker DJ. Demographic characteristics of patients undergoing aortic valve replacement for stenosis: relation to valve morphology. Heart. 1996 Feb;75(2):174–8.

    Article  CAS  Google Scholar 

  32. Aikawa E, Nahrendorf M, Sosnovik D, Lok VM, Jaffer FA, Aikawa M, et al. Multimodality molecular imaging identifies proteolytic and osteogenic activities in early aortic valve disease. Circulation. 2007 Jan 23;115(3):377–86.

    Article  CAS  Google Scholar 

  33. Aikawa E, Nahrendorf M, Figueiredo JL, Swirski FK, Shtatland T, Kohler RH, et al. Osteogenesis associates with inflammation in early-stage atherosclerosis evaluated by molecular imaging in vivo. Circulation. 2007 Dec 11;116(24):2841–50.

    Article  CAS  Google Scholar 

  34. Rabkin E, Aikawa M, Stone JR, Fukumoto Y, Libby P, Schoen FJ. Activated interstitial myofibroblasts express catabolic enzymes and mediate matrix remodeling in myxomatous heart valves. Circulation. 2001 Nov 20;104(21):2525–32.

    Article  CAS  Google Scholar 

  35. Abdelbaky A, Corsini E, Figueroa AL, Subramanian S, Fontanez S, Emami H, et al. Early aortic valve inflammation precedes calcification: a longitudinal FDG-PET/CT study. Atherosclerosis. 2015 Feb;238(2):165–72.

    Article  CAS  Google Scholar 

  36. Mohty D, Pibarot P, Després JP, Côté C, Arsenault B, Cartier A, et al. Association between plasma LDL particle size, valvular accumulation of oxidized LDL, and inflammation in patients with aortic stenosis. Arterioscler Thromb Vasc Biol. 2008 Jan;28(1):187–93.

    Article  CAS  Google Scholar 

  37. Olsson M, Thyberg J, Nilsson J. Presence of oxidized low density lipoprotein in nonrheumatic stenotic aortic valves. Arterioscler Thromb Vasc Biol. 1999 May;19(5):1218–22.

    Article  CAS  Google Scholar 

  38. Côté C, Pibarot P, Després JP, Mohty D, Cartier A, Arsenault BJ, et al. Association between circulating oxidised low-density lipoprotein and fibrocalcific remodelling of the aortic valve in aortic stenosis. Heart. 2008 Sep;94(9):1175–80.

    Article  Google Scholar 

  39. Miller JD, Chu Y, Brooks RM, Richenbacher WE, Peña-Silva R, Heistad DD. Dysregulation of antioxidant mechanisms contributes to increased oxidative stress in calcific aortic valvular stenosis in humans. J Am Coll Cardiol. 2008 Sep 2;52(10):843–50.

    Article  CAS  Google Scholar 

  40. Liberman M, Bassi E, Martinatti MK, Lario FC, Wosniak J Jr, Pomerantzeff PM, et al. Oxidant generation predominates around calcifying foci and enhances progression of aortic valve calcification. Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):463–70.

    Article  CAS  Google Scholar 

  41. Arsenault BJ, Boekholdt SM, Dubé MP, Rhéaume E, Wareham NJ, Khaw KT, et al. Lipoprotein(a) levels, genotype, and incident aortic valve stenosis: a prospective Mendelian randomization study and replication in a case-control cohort. Circ Cardiovasc Genet. 2014 Jun;7(3):304–10.

    Article  CAS  Google Scholar 

  42. El Husseini D, Boulanger MC, Mahmut A, Bouchareb R, Laflamme MH, Fournier D, et al. P2Y2 receptor represses IL-6 expression by valve interstitial cells through Akt: implication for calcific aortic valve disease. J Mol Cell Cardiol. 2014 Jul;72:146–56.

    Article  Google Scholar 

  43. Wada T, Nakashima T, Hiroshi N, Penninger JM. RANKL-RANK signaling in osteoclastogenesis and bone disease. Trends Mol Med. 2006 Jan;12(1):17–25.

    Article  CAS  Google Scholar 

  44. Kaden JJ, Bickelhaupt S, Grobholz R, Haase KK, Sarikoç A, Kiliç R, et al. Receptor activator of nuclear factor kappaB ligand and osteoprotegerin regulate aortic valve calcification. J Mol Cell Cardiol. 2004 Jan;36(1):57–66.

    Article  CAS  Google Scholar 

  45. Nagy E, Andersson DC, Caidahl K, Eriksson MJ, Eriksson P, Franco-Cereceda A, et al. Upregulation of the 5-lipoxygenase pathway in human aortic valves correlates with severity of stenosis and leads to leukotriene-induced effects on valvular myofibroblasts. Circulation. 2011 Mar 29;123(12):1316–25.

    Article  CAS  Google Scholar 

  46. Mathieu P, Bouchareb R, Boulanger MC. Innate and adaptive immunity in calcific aortic valve disease. J Immunol Res. 2015;2015:851945.

    Article  Google Scholar 

  47. Capoulade R, Mahmut A, Tastet L, Arsenault M, Bédard É, Dumesnil JG, et al. Impact of plasma Lp-PLA2 activity on the progression of aortic stenosis: the PROGRESSA study. JACC Cardiovasc Imaging. 2015 Jan;8(1):26–33.

    Article  Google Scholar 

  48. Tellis CC, Tselepis AD. The role of lipoprotein-associated phospholipase A2 in atherosclerosis may depend on its lipoprotein carrier in plasma. Biochim Biophys Acta. 2009 May;1791(5):327–38.

    Article  CAS  Google Scholar 

  49. Weiss RM, Lund DD, Chu Y, Brooks RM, Zimmerman KA, El Accaoui R, et al. Osteoprotegerin inhibits aortic valve calcification and preserves valve function in hypercholesterolemic mice. PLoS One. 2013 Jun 6;8(6):e65201.

    Article  CAS  Google Scholar 

  50. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739–91.

    Article  Google Scholar 

  51. Picano E, Pibarot P, Lancellotti P, Monin JL, Bonow RO. The emerging role of exercise testing and stress echocardiography in valvular heart disease. J Am Coll Cardiol. 2009 Dec 8;54(24):2251–60.

    Article  Google Scholar 

  52. Monin JL, Quéré JP, Monchi M, Petit H, Baleynaud S, Chauvel C, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003 Jul 22;108(3):319–24.

    Article  Google Scholar 

  53. Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J. 2016 Sep 7;37(34):2645–57.

    Article  Google Scholar 

  54. Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013 Dec 17;62(24):2329–38.

    Article  CAS  Google Scholar 

  55. Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014 Sep 23;64(12):1202–13.

    Article  Google Scholar 

  56. Omran H, Schmidt H, Hackenbroch M, Illien S, Bernhardt P, von der Recke G, et al. Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet. 2003 Apr 12;361(9365):1241–6.

    Article  Google Scholar 

  57. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10;63(22):e57–185.

    Article  Google Scholar 

  58. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med. 1999 Jul 15;341(3):142–7.

    Article  CAS  Google Scholar 

  59. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011 May;97(9):721–6.

    Article  Google Scholar 

  60. Mehrotra P, Jansen K, Flynn AW, Tan TC, Elmariah S, Picard MH, et al. Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction low-gradient severe aortic stenosis. Eur Heart J. 2013 Jul;34(25):1906–14.

    Article  CAS  Google Scholar 

  61. Jander N, Minners J, Holme I, Gerdts E, Boman K, Brudi P, et al. Outcome of patients with low-gradient “severe” aortic stenosis and preserved ejection fraction. Circulation. 2011 Mar 1;123(8):887–95.

    Article  Google Scholar 

  62. Tribouilloy C, Rusinaru D, Maréchaux S, Castel AL, Debry N, Maizel J, et al. Low-gradient, low-flow severe aortic stenosis with preserved left ventricular ejection fraction: characteristics, outcome, and implications for surgery. J Am Coll Cardiol. 2015 Jan 6;65(1):55–66.

    Article  Google Scholar 

  63. Harken DE, Soroff HS, Taylor WJ, Lefemine AA, Gupta SK, Lunzer S. Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg. 1960 Dec;40:744–62.

    Article  CAS  Google Scholar 

  64. Lee R, Li S, Rankin JS, O’Brien SM, Gammie JS, Peterson ED, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011 Mar;91(3):677–84; discussion p 684.

    Google Scholar 

  65. Brown ML, McKellar SH, Sundt TM, Schaff HV. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2009 Mar;137(3):670–679.e5.

    Google Scholar 

  66. David TE, Woo A, Armstrong S, Maganti M. When is the Ross operation a good option to treat aortic valve disease? J Thorac Cardiovasc Surg. 2010 Jan;139(1):68–73; discussion 73–5.

    Google Scholar 

  67. Stulak JM, Burkhart HM, Sundt TM 3rd, Connolly HM, Suri RM, Schaff HV, et al. Spectrum and outcome of reoperations after the Ross procedure. Circulation 2010 Sep 21;122(12):1153-1158.

    Google Scholar 

  68. David TE. Reoperations after the Ross procedure. Circulation. 2010 Sep 21;122(12):1139–40.

    Article  Google Scholar 

  69. Abdel-Wahab M, Mehilli J, Frerker C, Neumann FJ, Kurz T, Tölg R, et al. Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA. 2014 Apr 16;311(15):1503–14.

    Article  Google Scholar 

  70. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016 Apr 28;374(17):1609–20.

    Article  CAS  Google Scholar 

  71. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. 2020 Jan 29;382(9):799–809.

    Article  Google Scholar 

  72. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019 May 2;380(18):1695–705.

    Article  Google Scholar 

  73. Kapadia S, Stewart WJ, Anderson WN, Babaliaros V, Feldman T, Cohen DJ, et al. Outcomes of inoperable symptomatic aortic stenosis patients not undergoing aortic valve replacement: insight into the impact of balloon aortic valvuloplasty from the PARTNER trial (Placement of AoRtic TraNscathetER Valve trial). JACC Cardiovasc Interv. 2015 Feb;8(2):324–33.

    Article  Google Scholar 

  74. Walmsley T. The heart. In: Sharpey-Schafer E, Symington J, Bryce TH, eds. Quain’s elements of anatomy, 11th edn, vol 4, pt 3. London: Longmans, Greens & Co, 1929:42.

    Google Scholar 

  75. Ho SY. Anatomy of the mitral valve. Heart. 2002 Nov;88 Suppl 4(Suppl 4):iv5–10.

    Google Scholar 

  76. Bonninger M. Dtsch Med Wochenschr. 1908(34):2292. (a) Bluttransfusion bei pernizioser anamie: (b) Zwei Falle von Herzblock. Dtsch Med Wochenschr. 1908. 34: 2292.

    Google Scholar 

  77. Dewitzky W. Uber den Bau und die Enstehung verschiedener Formen der chronischen Veraderungen in der Herzklappen [German]. Virchow Arch Path Anat Physiol. 1910;199:273.

    Article  Google Scholar 

  78. Korn D, Desanctis RW, Sell S. Massive calcification of the mitral annulus. A clinicopathological study of fourteen cases. N Engl J Med. 1962 Nov 1;267:900–9.

    Article  CAS  Google Scholar 

  79. Roberts WC. Morphologic features of the normal and abnormal mitral valve. Am J Cardiol. 1983 Mar 15;51(6):1005–28.

    Article  CAS  Google Scholar 

  80. Fulkerson PK, Beaver BM, Auseon JC, Graber HL. Calcification of the mitral annulus: etiology, clinical associations, complications and therapy. Am J Med. 1979 Jun;66(6):967–77.

    Article  CAS  Google Scholar 

  81. Kizer JR, Wiebers DO, Whisnant JP, Galloway JM, Welty TK, Lee ET. Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: the Strong Heart Study. Stroke. 2005 Dec.;36(12):2533–7.

    Article  Google Scholar 

  82. Acarturk E, Bozkurt A, Cayli M, Demir M. Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease. Angiology. 2003 Sep–Oct;54(5):561–7.

    Article  Google Scholar 

  83. Mellino M, Salcedo EE, Lever HM, Vasudevan G, Kramer JR. Echographic-quantified severity of mitral anulus calcification: prognostic correlation to related hemodynamic, valvular, rhythm, and conduction abnormalities. Am Heart J. 1982 Feb;103(2):222–5.

    Article  CAS  Google Scholar 

  84. Nair CK, Sketch MH, Desai R, Mohiuddin SM, Runco V. High prevalence of symptomatic bradyarrhythmias due to atrioventricular node-fascicular and sinus node-atrial disease in patients with mitral anular calcification. Am Heart J. 1982 Feb;103(2):226–9.

    Article  CAS  Google Scholar 

  85. Mainigi SK, Chebrolu LH, Romero-Corral A, Mehta V, Machado RR, Konecny T. Prediction of significant conduction disease through noninvasive assessment of cardiac calcification. Echocardiography. 2012 Oct;29(9):1017–21.

    Article  Google Scholar 

  86. Watanakunakorn C. Staphylococcus aureus endocarditis on the calcified mitral annulus fibrosus. Am J Med Sci. 1973 Sep;266(3):219–23.

    Article  CAS  Google Scholar 

  87. Ramirez J, Flowers NC. Severe mitral stenosis secondary to massive calcification of the mitral annulus with unusual echocardiographic manifestations. Clin Cardiol. 1980 Aug;3(4):284–7.

    Article  CAS  Google Scholar 

  88. Aronow WS, Kronzon I. Correlation of prevalence and severity of mitral regurgitation and mitral stenosis determined by Doppler echocardiography with physical signs of mitral regurgitation and mitral stenosis in 100 patients aged 62 to 100 years with mitral anular calcium. Am J Cardiol. 1987 Nov 15;60(14):1189–90.

    Article  CAS  Google Scholar 

  89. Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Mitral annulus calcification. J Am Coll Cardiol. 2015 Oct 27;66(17):1934–41.

    Article  Google Scholar 

  90. Okada Y. Surgical management of mitral annular calcification. Gen Thorac Cardiovasc Surg. 2013 Nov;61(11):619–25.

    Article  Google Scholar 

  91. Carpentier AF, Pellerin M, Fuzellier JF, Relland JY. Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 1996 Apr;111(4):718–729; discussion 729–30.

    Google Scholar 

  92. Di Lullo L, Tripepi G, Ronco C, D’Arrigo G, Barbera V, Russo D, et al. Cardiac valve calcification and use of anticoagulants: preliminary observation of a potentially modifiable risk factor. Int J Cardiol. 2019 Mar 1;278:243–9.

    Article  Google Scholar 

  93. Bergler-Klein J, Klaar U, Heger M, Rosenhek R, Mundigler G, Gabriel H, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation. 2004 May 18;109(19):2302–8.

    Article  CAS  Google Scholar 

  94. Clavel MA, Malouf J, Michelena HI, Suri RM, Jaffe AS, Mahoney DW, et al. B-type natriuretic peptide clinical activation in aortic stenosis: impact on long-term survival. J Am Coll Cardiol. 2014 May 20;63(19):2016–25.

    Article  CAS  Google Scholar 

  95. Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB, et al. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005 Jun 9;352(23):2389–97.

    Article  CAS  Google Scholar 

  96. Rossebo AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008 Sep 25;359(13):1343–56.

    Article  Google Scholar 

  97. Chan KL, Teo K, Dumesnil JG, Ni A, Tam J, ASTRONOMER Investigators. Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation. 2010 Jan 19;121(2):306–14.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oxford University Hospitals NHS Foundation Trust, London, UK

    Jason Kho

  2. Department of Cardiothoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK

    Mario Petrou

  3. Imperial College School of Medicine, London, UK

    Mario Petrou

Authors
  1. Jason Kho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario Petrou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mario Petrou .

Editor information

Editors and Affiliations

  1. Umeå University, Umeå, Sweden

    Michael Henein

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kho, J., Petrou, M. (2022). Valve Calcification (Aortic and Mitral). In: Henein, M. (eds) Cardiovascular Calcification. Springer, Cham. https://doi.org/10.1007/978-3-030-81515-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81515-8_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81514-1

  • Online ISBN: 978-3-030-81515-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation