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Degenerative aortic stenosis increases in incidence with aging with patient presenting with symptomatic aortic stenosis above 80 years old. Congenital malformation of the aortic valve such as bicuspid aortic valve accelerates degeneration of the aortic valve and presents about 10 years earlier compared to normal trileaflet aortic valve. Less common risk factors include rheumatic heart disease, chronic renal failure and prior radiotherapy to the chest.