Severe valvular aortic stenosis in patients over 65 years of age: A clinicopathologic study

Abstract

Clinical and anatomic data are presented in 21 autopsy cases of patients over 65 years of age with severe valvular aortic stenosis. Attention is called to the unusual nature of the valvular lesion in the elderly compared to its manifestations in younger adults. The degree of aortic stenosis even in the very elderly may be extreme. The aortic valve in 2 patients was congenitally bicuspid, and in 19, tricuspid. The latter valves usually were characterized by the uniform distribution of nodular calcific deposits on the aortic aspects of the cusps and by the lack or near lack of commissural fusion. Calcification of the mitral annulus occurred in 16 of the 21 patients. Clinically, aortic stenosis in the elderly is characterized by several features that are either absent or more prominent than in younger subjects with this valvular lesion: The systemic arterial pulse pressure may be increased due to systolic hypertension; a harsh right basal systolic murmur may be relatively inconspicuous, whereas a pure musical systolic murmur may be prominent at the apex; a coexisting apical systolic murmur of mitral regurgitation may be related to mitral annular calcification and not to left ventricular failure; and systemic systolic hypertension can result in a comparatively small pressure gradient despite severe left ventricular outflow obstruction.