Aortic Stenosis

Pathophysiology: The commonest causes are bicuspid aortic valve, aortic valve sclerosis, and rheumatic valve disease.

CXR Findings: classic triad of aortic valve calcification, post-stenotic dilation of the ascending aorta, and left ventricular dilation.

Aortic valve calcification with any one other sign carries a 95% specificity for aortic stenosis.

“Aunt Sophies”:  Really none when at least one of the three findings are present along with aortic valve calcification:

1. With aortic valve calcification only: atherosclerosis, bicuspid sclerotic aortic valves, dystrophic calcification due to rheumatic valvulitis, bacterial endocarditis, calcification of proximal ascending aorta – multiple causes.
2. With dilation of ascending aorta only: arterial hypertension, ectasia and atherosclerosis, aneurysm of ascending aorta, large vessel vasculitis.
3. With left ventricular dilation: many causes: hypertension, underlying heart disease eg. heart failure, post-infarction, cardiomyopathies.