MDCT Evaluation of Aortic Valvular Disease
Robert C. Gilkeson1,
Alan H. Markowitz2,
Amit Balgude1 and
Peter B. Sachs1
1 Department of Radiology, University Hospitals of Cleveland and Case Medical
School, 11100 Euclid Ave., Cleveland, OH 44106-5000.
2 Department of Cardiothoracic Surgery, University Hospitals of Cleveland and
Case Medical School, Cleveland, OH 44106-5000.
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Fig. 1A —Optimal imaging planes for evaluation of aortic valve shown in
34-year-old man. Coronal multiplanar reconstruction view shows aortic valve
with imaging plane localizer (lines) in axial oblique plane.
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Fig. 1B —Optimal imaging planes for evaluation of aortic valve shown in
34-year-old man. Oblique axial image depicts aortic valve. R = right coronary
sinus, L = left coronary sinus, N = noncoronary cusp.
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Fig. 1C —Optimal imaging planes for evaluation of aortic valve shown in
34-year-old man. Cine CT image of aortic valve in axial oblique plane,
beginning in end-diastole. Single frame shows appearance of valve leaflets in
end-systole (arrows). On dynamic images, which are available online
(www.ajronline.org),
note opening of valve leaflets with symmetric effacement of aortic valve
during systole and complete closure with diastole.
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Fig. 1D —Optimal imaging planes for evaluation of aortic valve shown in
34-year-old man. Cine CT image of aortic valve in coronal plane. Single frame
shows complete coaptation of aortic valve (arrow) in diastole. On
dynamic images available online
(www.ajronline.org),
note symmetric opening of valve leaflets during cardiac cycle.
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Fig. 2 —42-year-old man who presented for evaluation of arrhythmias. Virtual
endoscopic image shows volume-rendered views of aortic valve during
end-diastole. Arrows denote valve leaflets and asterisks, aortic sinuses.
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Fig. 3A —28-year-old woman with Marfan syndrome who presented for evaluation
of status after undergoing St. Jude aortic valve replacement. Coronal
multiplanar reconstruction cine image of normal prosthetic valve motion.
Single frame shows symmetric opening of prosthetic components
(arrow). Prosthetic valve is intact. Dynamic images available online
(www.ajronline.org)
show complete coaptation of valvular components in diastole.
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Fig. 3B —28-year-old woman with Marfan syndrome who presented for evaluation
of status after undergoing St. Jude aortic valve replacement. Oblique sagittal
multiplanar reconstruction cine image of normal St. Jude's prosthetic valve.
Single frame shows symmetric opening of prosthetic components
(arrow). Dynamic images available online
(www.ajronline.org)
show symmetric opening of prosthetic valve leaflets in systole in view of left
ventricle outflow tract.
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Fig. 3C —28-year-old woman with Marfan syndrome who presented for evaluation
of status after undergoing St. Jude aortic valve replacement. Virtual
endoscopic images show prosthetic valve in diastole (C) and in systole
(D). Note origins of reimplanted coronary arteries
(arrows).
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Fig. 3D —28-year-old woman with Marfan syndrome who presented for evaluation
of status after undergoing St. Jude aortic valve replacement. Virtual
endoscopic images show prosthetic valve in diastole (C) and in systole
(D). Note origins of reimplanted coronary arteries
(arrows).
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Fig. 4A —38-year-old man who presented with chest pain and widened
mediastinum. Oblique axial cine image shows aortic valve. Single frame shows
appearance of classic bicuspid valve (arrow). Note symmetric opening
of right and left aortic cusps during cardiac cycle.
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Fig. 4B —38-year-old man who presented with chest pain and widened
mediastinum. Virtual endoscopic view of aorta in systole shows symmetric
appearance of bicuspid valve with ellipsoid configuration of open valve
(arrow).
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Fig. 5A —78-year-old woman with aortic stenosis. Oblique axial CT image of
aortic valve shows slightly thickened, markedly stenotic bicuspid valve
(arrow) in systole.
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Fig. 5B —78-year-old woman with aortic stenosis. Corresponding virtual
endoscopic view of aortic valve in systole. Arrow denotes thickened valve
leaflets, and arrowhead shows associated valvular calcification.
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Fig. 6 —58-year-old man with aortic valve stenosis. Cine image shows
moderately stenotic bicuspid aortic valve. Single frame shows thickened valve
leaflets (arrow) and partial fusion of left and right coronary cusps
(asterisk). Dynamic images available online
(www.ajronline.org)
confirm limited excursion of bicuspid valve leaflets.
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Fig. 7 —78-year-old woman with history of calcific aortic stenosis. Virtual
endoscopic view shows heavily calcified valve. While left coronary artery
orifice (arrow) is visualized, right coronary artery orifice is
obscured by heavy calcification.
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Fig. 8A —60-year-old woman with chest pain. Oblique axial image of aortic
valve shows large sinus of Valsalva aneurysm (arrow) arising from
noncoronary cusp.
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Fig. 8B —60-year-old woman with chest pain. Oblique axial image of aortic
valve shows interval thrombosis of sinus of Valsalva aneurysm (arrow)
after surgical exclusion.
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Fig. 9 —72-year-old woman with echocardiographic evidence of severe aortic
stenosis. Oblique axial image shows extensive aortic valve calcification
(arrow), consistent with degenerative aortic stenosis.
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Fig. 10A —70-year-old man with aortic stenosis by echocardiography. Coronal
cine CT image shows thickened, calcified degenerative aortic valve.
Single-frame image shows updoming of valve leaflets and stenosis of aortic
valve orifice (arrow). Dynamic images available online
(www.ajronline.org)
confirm valve stenosis and illustrate associated left ventricular
hypertrophy.
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Fig. 10B —70-year-old man with aortic stenosis by echocardiography. Oblique
axial cine CT image of aortic valve. Single frame shows thickened and stenotic
aortic valve (arrow). Comparison of dynamic images available online
(www.ajronline.org)
with Figure 10C, also available online, illustrates markedly compromised valve
opening.
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Fig. 11 —52-year-old man with history of Marfan syndrome. Coronal multiplanar
reconstruction cine image shows aortic insufficiency. Single frame shows lack
of coaptation of aortic valves during diastole (arrow). Findings
depicted on dynamic images of aortic insufficiency, which are available online
(www.ajronline.org),
correlated with findings at echocardiography.
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Fig. 12A —72-year-old woman with suspected type A dissection. Coronal
multiplanar reconstruction image shows complex type A dissection. Although
flap (arrow) is discontinuous in mid ascending aorta, there is
extension of dissection into aortic root (arrowhead).
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Fig. 12B —72-year-old woman with suspected type A dissection. Cine evaluation
at aortic valve plane. Single frame reveals that dissection (arrow)
extends into noncoronary cusp. Dynamic images available online
(www.ajronline.org)
show involvement of noncoronary cusp with preservation of valve function.
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Fig. 12C —72-year-old woman with suspected type A dissection. Virtual
endoscopic view shows fenestrated dissection flap (arrow) with
extension into noncoronary cusp.
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Fig. 13A —57-year-old man with chest pain and pulmonary edema. Sagittal
oblique cine imaging of aortic valve. Single frame shows dissection flap
(arrows) within proximal ascending aorta. Dynamic views available
online
(www.ajronline.org)
show dissection flap prolapsing through aortic valve in diastole.
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Fig. 13B —57-year-old man with chest pain and pulmonary edema. Coronal cine
image. Single-frame image defines relationship of dissection flap to left
coronary artery (arrow). Dynamic images available online
(www.ajronline.org)
confirm intermittent obstruction of left coronary artery and prolapse through
aortic valve.
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Fig. 14A —35-year-old man with fever and bacteremia 2 years after stentless
aortic valve replacement. Axial oblique cine image of aortic valve. Single
frame shows vegetation (arrow) in region of right coronary cusp.
Dynamic images available online
(www.ajronline.org)
confirm mobile vegetation is occupying right aortic sinus.
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Fig. 14B —35-year-old man with fever and bacteremia 2 years after stentless
aortic valve replacement. Virtual endoscopic view of aortic valve shows
vegetation (arrow) within right coronary sinus. Cardiac surgery
reconfirmed periaortic valve abscess and valvular vegetations.
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Fig. 15A —45-year-old woman with history of systemic lupus erythematosus and
clinical evidence of peripheral arterial emboli. Axial oblique ECG-gated view
of aortic valve in diastole shows well-defined soft-tissue mass
(arrow) on aortic valve.
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Fig. 15B —45-year-old woman with history of systemic lupus erythematosus and
clinical evidence of peripheral arterial emboli. Coronal multiplanar
reconstruction view confirms well-defined soft-tissue vegetation
(arrow) on aortic valve.
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Fig. 15C —45-year-old woman with history of systemic lupus erythematosus and
clinical evidence of peripheral arterial emboli. Surface-shaded virtual
endoscopy with tissue segmentation shows endoscopic view of this vegetation
(arrow) in relation to right and left coronary cusp, which at surgery
was consistent with Libman-Sacks endocarditis.
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Fig. 16 —21-year-old woman with Takayasu's arteritis, chest pain, and widened
mediastinum. Oblique axial image shows dilation of aortic root with dilation
of involved aortic sinuses (arrow).
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Copyright © 2006 by the American Roentgen Ray Society.
