CT and MR imaging of the aortic valve: radiologic-pathologic correlation

Area of Science:

• Cardiology
• Radiology
• Cardiac Surgery

Background:

• Valvular disease constitutes up to 20% of US cardiac surgeries.
• Bicuspid aortic valve is a common congenital anomaly leading to stenosis, regurgitation, endocarditis, and aortic dilatation.
• Aortic stenosis and regurgitation present as dephasing jets on MR imaging.

Purpose of the Study:

• To summarize the clinical significance of bicuspid aortic valve disease.
• To highlight the role of advanced imaging in diagnosis and management.
• To discuss treatment options including surgery and transcatheter aortic valve implantation (TAVI).

Main Methods:

• Magnetic resonance (MR) imaging for detecting dephasing jets in stenosis and regurgitation.
• Computed tomography (CT) for preoperative planning of TAVI, assessing aortic dimensions, and vascular disease.
• Doppler ultrasonography for grading aortic regurgitation severity.

Main Results:

• Severe symptomatic aortic stenosis or regurgitation typically requires valve replacement or TAVI.
• CT is essential for TAVI planning, evaluating aortic root, peripheral vasculature, and coronary arteries.
• Electrocardiographically gated CT can identify infectious vegetations in endocarditis.

Conclusions:

• Bicuspid aortic valve disease necessitates comprehensive evaluation and management.
• Advanced imaging modalities are integral to diagnosing valvular heart disease and guiding therapeutic interventions.
• Timely intervention for severe valvular disease improves patient outcomes and reduces morbidity.