Use of complementary electrocardiogram-gated cardiac computed tomography in the assessment of aortic valve...

In young patients with type I/II aortic regurgitation, the feasibility of aortic valve (AV) repair has been traditionally evaluated with echocardiography. We evaluate electrocardiogram (ECG)-gated cardiac computed tomography as a complement to transoesophageal echocardiography in the preoperative assessment of aortic repairability.

Patients undergoing non-urgent AV repair with or without aortic root replacement from October 2016 to May 2023 who had both imaging tests for the evaluation of AV repairability were included. The measurements obtained with echocardiography and ECG-gated scan of geometric height, aortic annulus and commissural orientation were compared using the intraclass correlation coefficient for inter-rater reliability.

All 24 patients were males, with a median age of 47.5 years (41.9-59.3). Of these, 87.5% presented severe aortic regurgitation; 62.5% had associated aortopathy. 58.3% were in New York Heart Association class I and the remnant 41.7% in class II. The AV was bicuspid in 62.5% of the patients. The intraclass correlation coefficient indicated excellent reliability of ECG-gated scan for commissural orientation (ICC = 0.98, 95% CI: 0.96-0.99) and conjoined cusp geometric height (ICC = 0.91, 95% CI: 0.74-0.97) in bicuspid AVs, while in tricuspid valves it showed good reliability for left cusp geometric height (ICC = 0.76, 95% CI: 0.19-0.93) and annular diameter (ICC = 0.8, 95% CI: 0.33-0.95).

ECG-gated cardiac scan complements echocardiography in aortic repair, showing excellent agreement for morphologic evaluation and commissural orientation. It is particularly reliable for geometric height in bicuspid valves and annular diameter and left cusp geometric height in tricuspid valves.