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Cardiovascular Pathology
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Case 1 -
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Degenerative Fibrocalcific Aortic Valve Disease, Associated with Clinically Severe Aortic Stenosis and No Aortic Regurgitation
William D. Edwards
Mayo Clinic
Rochester, MN
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Clinical History
A 73-year-old man was referred to the Mayo Clinic for worsening chest pain an shortness of breath. He had a two-year history of exertional chest discomfort. For the past two weeks, exertional chest pain had become more frequent and intense than previously, and it now radiated to the left shoulder. During this time, he has also developed nocturnal chest pain.
Coronary arteriography was performed and showed severe three-vessel disease, with 100% occlusion of the proximal RCA, 99% stenosis of the proximal LAD, and 80% stenoses of the LAD-D1 and LCX-OM1. An echocardiographic examination revealed severe aortic stenosis, with an effective valve orifice area of 0.6 cm2, moderate mitral regurgitation, an ejection fraction of 34%, and moderate left ventricular and left atrial dilatation.
Clinical diagnoses included severe coronary artery disease, unstable angina pectoris, severe aortic stenosis, and moderate systolic dysfunction. He underwent coronary artery bypass graft surgery and aortic valve replacement with a bioprosthetic valve. Gross photographs and a radiogram of the excised valve are provided for determination of the cause of aortic stenosis.
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