Aortic valve thickening (sclerosis) without stenosis is common in elderly adults . It is often detected either as a systolic murmur on physical examination or on echocardiography performed for some other reason. Aortic valve sclerosis is important clinically because it can progress to aortic stenosis and is a marker for increased cardiovascular risk.
DEFINITION AND ECHOCARDIOGRAPHY
Aortic valve sclerosis is defined by the following features on echocardiography [1-4]:
- Irregular leaflet thickening and focal increased echogenicity (calcification) are the hallmarks of the condition. Focal areas of thickening are typically seen on the aortic side of the valve in the center of the valve cusp, rather than at the leaflet edges, often initially involving the noncoronary cusp.
- Leaflet excursion is not impaired and the commissures are not fused. Peak continuous wave Doppler flow velocities across the valve are normal or only minimally elevated (<2.0 m/sec).
Reduction in leaflet mobility, increase in leaflet calcification, and increase in aortic transvalvular Doppler flow velocities are signs of progression from aortic sclerosis to aortic stenosis. (See 'Progression' below.)
Mitral annular calcification frequently accompanies aortic valve sclerosis [5,6]. (See "Echocardiographic evaluation of the mitral valve", section on 'Mitral annular calcification'.)