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Four-dimensional computed tomography analysis of bicuspid aortic valves.
Amine Fikani1,2, Damian Craiem3, Cyrille Boulogne4
1Department of Cardiothoracic and Vascular Surgery, University Medical Center Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon.
JTCVS Techniques
|October 31, 2024
Summary
Four-dimensional cardiac computed tomography (4D MCCT) effectively characterizes the aortic annulus in bicuspid aortic valves (BAV). This advanced imaging distinguishes BAV types and assesses aortic root morphology, aiding in understanding BAV variations.
Area of Science:
- Cardiovascular Imaging
- Cardiac Anatomy
- Medical Diagnostics
Background:
- Bicuspid aortic valve (BAV) is a common congenital heart defect.
- Accurate characterization of the aortic annulus (AA) and aortic root is crucial for managing BAV.
- Current imaging techniques may have limitations in fully describing the complex 3D morphology of the BAV aorta.
Purpose of the Study:
- To evaluate the utility of 4-dimensional (4D) multiphase cardiac computed tomography (MCCT) for describing the aortic annulus (AA) in patients with bicuspid aortic valves (BAV).
- To compare 4D MCCT findings in BAV with normal tricuspid aortic valves (TAV).
- To assess the ability of 4D MCCT to classify BAV types based on the latest expert consensus.
Main Methods:
- Electrocardiography-gated MCCT was performed on 15 patients with BAV and 15 patients with TAV.
- In-house software was used to analyze the AA on 9 reconstructed planes, interpolating 3D coordinates to calculate morphometric parameters (area, perimeter, diameters, eccentricity, height) across 10 cardiac phases.
- Additional planes assessed the left ventricular outflow tract (LVOT), sinus of Valsalva, and sinotubular junction.
Main Results:
- The AA was significantly larger in BAV compared to TAV (indexed area, P < .001), as were the Valsalva sinuses and sinotubular junction.
- 3D AA shape analysis differentiated BAV types (symmetrical, fused, partial-fusion/form fruste) and determined the nonfunctional commissure's position and height.
- Symmetrical BAV showed a lower nonfunctional commissure compared to TAV and asymmetrical BAV (P < .001); asymmetrical BAV had comparable commissure heights (P = .316).
- A spectrum of ellipticity was observed in the LVOT and sinuses of Valsalva among TAV, asymmetrical BAV, and symmetrical BAV.
Conclusions:
- 3D morphometric analysis of BAV using MCCT enables precise identification of BAV subtypes and nonfunctional commissure characteristics.
- Significant morphological differences exist in the aortic root between TAV and various BAV types.
- Further research is warranted to explore the impact of 3D analysis on procedural planning for pathological BAV.
