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Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

Alexandra Platon1, Stephane Bernard1, Nils Perrin1

  • 1Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.

European Journal of Radiology
|October 26, 2016
PubMed

Insights

Measuring the diameter of the sinuses of Valsalva on non-ECG-gated CT scans can predict aortic valve involvement in patients with Type A aortic dissection (AD). This finding aids in surgical planning for AD patients.

Area of Science:

  • Cardiovascular Imaging
  • Thoracic Surgery
  • Diagnostic Radiology

Background:

  • Type A aortic dissection (AD) is a life-threatening condition requiring prompt surgical intervention.
  • Aortic valve involvement is a critical factor influencing surgical outcomes in Type A AD.
  • Non-electrocardiogram (ECG)-gated computed tomography (CT) is often the initial imaging modality for suspected AD.

Purpose of the Study:

  • To identify predictive imaging signs of aortic valve involvement on non-ECG-gated admission CT scans in patients with Type A AD.
  • To assess the utility of specific aortic measurements in predicting valvular complications.

Main Methods:

  • Retrospective analysis of non-ECG-gated CT examinations in 20 patients surgically treated for Type A AD.
  • Measurement of aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta diameters.
  • Comparison of CT measurements with intraoperative findings of aortic valve involvement.

Main Results:

  • 55% of patients (11/20) had surgically confirmed aortic valve involvement.
  • Significantly larger mean diameters of the sinus of Valsalva were observed in patients with valvular involvement (44.3 mm vs. 38.1 mm).
  • The diameter of the sinus of Valsalva was the only parameter significantly predictive of aortic valve involvement (p=0.02).

Conclusions:

  • The diameter of the sinuses of Valsalva measured on non-ECG-gated admission CT is a significant predictor of aortic valve involvement in Type A AD.
  • This simple measurement can aid in preoperative risk stratification and surgical planning for Type A AD patients.
Abstract

Keywords:
Aortic dissectionAortic valvesEmergencyNon-ECG gated CT

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