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In Reply: We are unable to address Mr Song's question about the extent of aortic valve calcification and whether it was predictive of primary cardiac events because valvular calcification was not examined in our study. However, a recent study of patients with a normal or minimally dysfunctional bicuspid valve was apparently the first to report the prognostic role of an index of aortic valve degeneration that incorporated the extent of valve thickening, calcification, and mobility.¹ While the extent of valvular calcification has been shown to independently predict outcomes in asymptomatic older adults with severe aortic stenosis,² valve calcification may be only one of several factors that predict outcomes in younger patients with bicuspid aortic valve.

Financial Disclosures: None reported.

Samuel Siu, MD
samuel.siu@lhsc.on.ca
University of Western Ontario
London, Ontario, Canada

1. Michelena HI, Desjardins VA, Avierinos JF; et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation. 2008;117(21):2776-2784. FREE FULL TEXT 2. Rosenhek R, Binder T, Porenta G; et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611-617. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(9):936.

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