Aortic valve sclerosis: new help from echocardiography in the assessment of cardiovascular risk.

The normal aortic valve leaflets consist of a single layer of endothelial cells that envelopes the spongiosa on the aortic side, and the ventricularis on the ventricular side, whereas the central collagenous layer is the fibrosa characterized by a dense collagen [1,2]. Aortic sclerosis probably starts with an endothelial disruption on the aortic side yielding to thickening of the subendothelium and adjacent fibrosa due to accumulation of lipids and inflammatory cells. These aggregates colocalize with areas of microscopic calcification, and somemacrophages produce osteopontin, a protein involved in the calcification process. Angiotensin-converting enzyme with local production of angiotensin II has been also identified in human sclerotic aortic valves [1–4]. This stage can be visualized by echocardiography as an irregular leaflet thickening without commissural fusion and stenosis.

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