Aortic valve grossing

This article covers aortic valve grossing. The aortic valve usually comes to pathology because of calcific aortic stenosis; however, there are a few less common reasons it may come.

Mitral valve grossing is dealt with in a separate protocol.

Introduction

• The vast majority of valves are calcific aortic stenosis and can be proven by the "drop test"; if you drop a calcified valve on a metal surface it goes "clank". Most patients are in their 70s.
  • If a patient is younger (50s or younger) one should look carefully for fusion, i.e. bucuspid valve.
• Vegetations are usually along the free edge.
• Thinning is suggestive of myxomatous degeneration. Myxomatous degeneration is something that is seen in connective tissue disorders, e.g. Marfan syndrome; it tends to be in younger people.
• Bicuspid aortic valve = leftlets fused and no raphe (uncommon) or raphe does not reach the free margin of the cusp.

Protocol

• Specimen: aortic valve tissue.
• Number of cusps: [ number ].
• Measurements (base-to-free edge x along the free edge x thickness): H x L x T, H x L x T and H x L x T cm.
• Calcification: [ absent / suspicious / present ], [minimal / moderate / marked].
• Vegetations: [ none / suspicious / present ].
• Thinning: [ absent / suspicious / present ].
• Additional findings: [ none / fenestrations ].
• Representative sections are submitted from each cusp in block A1.

Protocol notes

• May be a gross only diagnosis.
• Sections are cut perpendicular to the free edge.

Alternate approaches

• None.

Pathology

• 

  Calcific aortic stenosis (WC)

Additional images:

• Bicuspid valve (ahajournals.org).

See also

• Heart valves.
• Cardiovascular pathology.

Related protocols

• Mitral valve grossing.