Pathological characteristicDefinitionScore
Leaflet thickeningMildThickening is confined to the margins of the leaflets; thickened leaflet area is less than one-third of the leaflet area; leaflet mid portions and base portions have normal mobility1
Leaflet thickeningModerateOne half of the leaflet area is thickened and stiff; other portions have normal mobility2
Leaflet thickeningSevereAll or most leaflet portions are thickened and stiff3
Leaflet calcificationMildSurface of the leaflet has calcified spots, but calcification does not affect the full thickness of the leaflet2
Leaflet calcificationModerateSingle, localised, calcification area, the diameter of which is <1 cm4
Leaflet calcificationSevereFull thickness of the leaflet is calcified and the diameter is >1 cm, or more than one-third of the leaflet area is calcified6
Leaflet contractureMildHeight of the anterior valve is <2.5 cm; height of the posterior valve is <1.5 cm1
Leaflet contractureSevereHeight of the anterior valve is <2 cm; height of the posterior valve is <1 cm2
Chordae tendineae thickeningMildOnly some major chordae tendineae are thickened; thickening is confined to the joint between the leaflet and chordae tendineae1
Chordae tendineae thickeningModerateLess than half of the major chordae tendineae are thickened2
Chordae tendineae thickeningSevereAll or most major chordae tendineae are thickened and thickening reaches the papillary muscles3
Chordae tendineae fusionMildNot more than 3 chordae tendineae fused2
Chordae tendineae fusionSevereMore than 3 chordae tendineae fused4
Chordae tendineae calcificationMildThe end of the single or multiple chordae tendineae is calcified but does not fuse2
Chordae tendineae calcificationSevereMultiple chordae tendineae are fused and calcified; they are shaped like a ball2
Chordae tendineae shorteningMildClearly distinguished structures of papillary muscles, chordae tendineae, and margins of leaflets; length of major chordae tendineae is >0.5 cm4
Chordae tendineae shorteningSevereIndistinguishable structures of papillary muscles, chordae tendineae, and margins of leaflets; length of the major chordae tendineae is <0.5 cm or the leaflet is almost directly connected with the papillary muscle2
Commissural fusionMildLength of commissural fusion is <1 cm4
Commissural fusionModerateLength of commissural fusion is between 1 cm and 2 cm1
Commissural fusionSevereLength of commissural fusion is >2 cm2
Commissural fusionSevereLength of commissural fusion is >2 cm3
Commissural calcificationMildScope of commissural calcification is less than half; the whole commissure retains partial mobility2
Commissural calcificationSevereThe whole commissure is calcified and fixed, thereby losing mobility4