Artherosclerotic disease usually affects one valve or the other.

• A. True
• B. False
• C. Sometimes
• D. Not sure

Answer: (A)

Atherosclerotic valvular changes are usually focal and confined to a single valve or its annulus, rather than spreading across multiple valves. In the heart, calcific degeneration typically targets the aortic valve, especially with age, leading to calcific aortic stenosis, or it can involve the mitral annulus with calcification. Seeing disease that involves more than one valve at once is atypical for atherosclerotic processes and should prompt consideration of other conditions such as rheumatic disease, endocarditis, or systemic inflammatory processes that more commonly affect multiple valves. On ultrasound, you’d expect to see discrete calcification confined to one valve (most often the aortic valve) rather than diffuse involvement of several valves.