title: Deep Crater in Heavily Calcified Aortic Valve Leaflet: A "Smoking Gun" for Embolic Stroke.
abstract: The association of severe calcific aortic stenosis with clinically significant stroke has not been well established. This case vividly describes the relationship with clinical and pathological (gross and microscopic) findings in a 62-year-old man with a severely calcified bicuspid aortic valve. Eleven months prior to aortic valve surgery, the patient had stigmata of cerebral embolic events in the absence of any other embolic source. During the aortic valve replacement surgery for aortic stenosis, he was found to have a large atheroma on the aortic valve cusp with a crater containing friable debris in its center. These findings support the potential for embolic stroke in patients with severe calcific aortic stenosis. We recommend that the aortic valve be considered as an embolic source in patients with an otherwise cryptogenic cerebrovascular accident.
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Sarah Chaoying
authors.initials: SC
authors.lastname: Xu
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Canter
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zeeshan
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
keywords: Aortic valve replacement; Bicuspid aortic valve; Calcified aortic valve; Cerebrovascular events