Pre-procedural multi-slice computed tomography (MSCT) in aortic valve replacement. Important measurements

Abstract

Purpose: To describe the preoperative role of MSCT in aortic valve lesions regarding detection of valve morphological changes and important measurements needed for valve replacement. Subjects and methods: This was a prospective study included 24 patients their mean age 53.4 years, with known aortic valve stenosis (AS) or regurgitation (AR) over a study period 1 year. All patients underwent CT angiography using 128 MSCT. The coronary angiography was done by means of a bolus tracking technique. Measurements were conventionally made from an “optimized” sagittal oblique left ventricular outflow tract (LVOT) reconstruction. Results: The most common cause for aortic valve lesion was degenerative (63%). Echocardiography (ECHO) and MSCT had highly statistically significant kappa agreement in differentiating AS and AR. The mean aortic valve area (AVA) in AS and AR were (1.2 ± 0.5 and 3.8 ± 0.3 cm2) with p value (0.000∗∗). Aortic valve dimension at sinus of valsalva were (3.5 ± 0.2 & 4.6 ± 0.7 cm) in AS and AR respectively. At the sino-tubular junction (STJ) were (3.1 ± 0.2 & 4.4 ± 1.4) in AS and AR respectively. The mean aortic annulus area was (5.7 ± 1.3 cm2) in AS and (6.6 ± 0.8 cm2) in AR. MSCT was more significant than ECHO in detection and grading of calcification (p value 50% attenuated lumen was detected in (25% &12.5%) of our patients respectively. Conclusion: The familiarity with the MSCT features of aortic valve and using various measurements are considered to be helpful for the accurate diagnosis and proper pre-operative valve replacement preparation.

Keywords

• MSCT
• AS
• Aortic valve
• Valve replacement