CARDIOVASCULAR MEDICINE

Atherosclerosis-like lesions of the aortic valve are common in adults of all ages: a necropsy study

J Kuusisto¹, K Räsänen², T Särkioja³, E Alarakkola⁴, V-M Kosma⁵

¹ Department of Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
² Department of Anaesthesiology, University of Helsinki, Helsinki, Finland
³ Department of Forensic Medicine, University of Oulu, Oulu, Finland
⁴ Department of Pathology, University of Helsinki, Helsinki, Finland
⁵ Department of Pathology, University of Tampere and Tampere University Hospital, Tampere, Finland

Correspondence to:
Correspondence to:
Dr Johanna Kuusisto
Cardiology Unit, Department of Medicine, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland; johanna.kuusisto{at}kuh.fi

Objective: To determine the presence and size of atherosclerosis-like lesions in aortic valves of unselected adults of all ages.

Design: Necropsy study.

Setting: Departments of Forensic Medicine and Pathology at the University of Oulu and the Oulu University Hospital in Finland.

Subjects: 48 consecutive unselected adult subjects (15 subjects aged 20–40 years, 17 aged 41–60, and 16 aged 61) undergoing necropsy.

Main outcome measures: Detection of the presence of atherosclerosis-like lesions and mineralisation in aortic valves, and morphometrical measurement of the size of lesions.

Results: None of the necropsy subjects had aortic stenosis and only two subjects had macroscopic calcification of the aortic valve. Of 48 subjects, however, 45 had an atherosclerosis-like subendothelial thickening above the elastic lamina on the aortic side of at least one of the valve leaflets. Of 15 young subjects aged 20–40 years, eight had a lesion in the right coronary cusp of the aortic valve and 12 had a lesion in at least one of the three aortic valve leaflets. Of 17 middle aged subjects, 16 had an early lesion in the right coronary cusp and all had a lesion in at least one of the valve leaflets. In the oldest age group, all 16 subjects had a lesion in every valve leaflet. The mean lesion area in the three valve leaflets varied from 0.1–0.2 mm² in young subjects, 0.5–0.8 mm² in middle aged, and 1.3–2.3 mm² in elderly subjects (p < 0.001). Microscopic calcification in the right coronary cusp of the aortic valve was observed in 12 of 17 middle aged and 14 of 16 elderly subjects but only in one young subject.

Conclusions: Atherosclerosis-like lesions in the aortic valve are prevalent in adults of all age groups, including young subjects aged 20–40 years, suggesting that the disease process leading to aortic stenosis is common, often beginning in early adulthood.

Keywords: aortic stenosis; atherosclerosis; lesion; young adults; coronary disease

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