Aortic valve grossing

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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.[1]

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

Additional images:

See also

Related protocols

References

  1. Rose, Alan G. (2008). Atlas of Gross Pathology with Histologic Correlation (1st ed.). Cambridge University Press. pp. 2. ISBN 978-0521868792.
  2. Fedak, PW.; Verma, S.; David, TE.; Leask, RL.; Weisel, RD.; Butany, J. (Aug 2002). "Clinical and pathophysiological implications of a bicuspid aortic valve.". Circulation 106 (8): 900-4. PMID 12186790.