CALCIFIED AORTIC VALVE CLINICAL AND RADIOLOGICAL FEATURES

The object of this paper is to suggest that a diagnosis of calcified aortic valve can justifiably be made more often than is the current practice, and that the lesion can be convincingly demonstrated and permanently recorded by a special radiological technique not hitherto described. Rayger described the first recorded case of calcified aortic valve in 1697: he performed an autopsy, and sent one of the calcified cusps to Bonet, who described it in a publication dated 1700. A few years later Cowper (1706) described a man of forty with dyspnoea, angina, faintness and petrifaction of the aortic valve-" the valves of the Great Artery were Petrify'd insomuch that they could not approach each other. " Further cases were reported by Vieussens (1715), Chevers (1842), Lloyd (1846), and Peacock (1868). Lannaec (1829) gives an excellent clinical description. The earliest extensive pathological account is that of Hasse (1846). In more modern times, calcified aortic valve was neglected until 1931, when Christian reported a series of 22 cases, and attempted to lay down clinical criteria for the diagnosis. Interest was further aroused by the paper of Sosman and Wosika (1933) on radiological demonstration of valvular calcification, and there have been numerous American papers on all aspects of the subject up to the present time. The English papers on the subject, however, are extremely scanty. Bennett (1930) reported a single case, and Gibbs (1935) described the pathology. Campbell and Shackle (1932) give the lesion passing mention in a general survey of aortic disease. The fullest account written in this country was that of Campbell (1937). Frequency of the lesion. Hall and Ichioka (1940) found 31 cases of calcified aortic valve in 4000 autopsies: Dry and Willius (1939) found 23 cases in 2616 consecutive autopsies, and they further pointed out that calcified aortic valve constitutes 18 per cent 126 of all healed valvular defects. The highest incidence of the lesion was that reported by Sophian (1945) who found 31 cases in 500 consecutive autopsies at the U.S. Marine Hospital. He attributed the high incidence of the lesion in his cases to age, sex, and occupation. Thus it appears that, although the available figures show a fairly wide range of variation, the lesion is undoubtedly quite common. While discussing the incidence of the lesion, it is interesting to note how infrequently aortic stenosis occurs without calcification of the valve cusps. In Christian's series (1931) of 22 cases there was calcification in all but one; Dry and Willius (1939) reported 116 cases that came to necropsy, in all of which calcification was found, and 122 cases diagnosed clinically with radiologically demonstrable calcification. This shows that calcification occurs early in aortic stenosis and is almost always present by the time of death or diagnosis. Unfortunately there are few figures available to show how frequently calcified aortic valve is diagnosed in life. Blackford and Bryan (1936) found less than 50 reported cases, that had been diagnosed in life, up to 1936. Berk and Dinnerstein (1938) reported 16 cases, of which only 5 were diagnosed in life, while Reich (1945) reported 22 cases, of which 11 were diagnosed. The later series show a much greater frequency of diagnosis than those prior to 1932: e.g. Margolis et al. (1931) reported 42 cases, of which only 2 were correctly diagnosed in life.