Not Every Calcified Aortic Valve Is Rheumatic! Today, one of my trainees described mild focal calcification of the aortic valve as “rheumatic involvement.” It sparked a great teaching discussion! How often does rheumatic heart disease involve the aortic valve in isolation? ✅Isolated aortic involvement accounts for <8% of rheumatic heart disease. ✅ Isolated rheumatic aortic stenosis is even rarer (~2%). ✅ Rheumatic aortic regurgitation is more common than isolated rheumatic AS. ✅ Most rheumatic aortic valve disease occurs alongside mitral valve involvement. 🔍 What should we look for on echo? 🫀Commissural fusion — a hallmark of chronic rheumatic valvular disease. 🫀 Leaflet thickening, particularly at the free edges. 🫀 Restricted leaflet mobility. 🫀 Progressive fibrosis and calcification. Calcification alone does not establish rheumatic etiology. Before calling an aortic valve rheumatic, look at the commissures—and don’t forget the mitral valve! Sometimes, the most important imaging finding is what isn’t there. #EchoFirst #CVImaging #RheumaticHeartDisease #CardioTea PS found this really nice schematic on insta- if anyone knows the author on X please tag him. I am not able to find him here!