CT and MR imaging of the aortic valve

Radiologic-pathologic correlation

Christopher J. Bennett, Joseph Maleszewski, Philip A Araoz

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Valvular disease is estimated to account for as many as 20% of cardiac surgical procedures performed in the United States. It may be congenital in origin or secondary to another disease process. One congenital anomaly, bicuspid aortic valve, is associated with increased incidence of stenosis, regurgitation, endocarditis, and aneurysmal dilatation of the aorta. A bicuspid valve has two cusps instead of the normal three; resultant fusion or poor excursion of the valve leaflets may lead to aortic stenosis, the presence of which is signaled by dephasing jets on magnetic resonance (MR) images. Surgery is generally recommended for patients with severe stenosis who are symptomatic or who have significant ventricular dysfunction; transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option for patients who are not eligible for surgical treatment. Computed tomography (CT) is an essential component of preoperative planning for TAVI; it is used to determine the aortic root dimensions, severity of peripheral vascular disease, and status of the coronary arteries. Aortic regurgitation, which is caused by incompetent closure of the aortic valve, likewise leads to the appearance of jets on MR images. The severity of regurgitation is graded on the basis of valvular morphologic parameters; qualitative assessment of dephasing jets at Doppler ultrasonography; or measurements of the regurgitant fraction, volume, and orifice area. Mild regurgitation is managed conservatively, whereas severe or symptomatic regurgitation usually leads to valve replacement surgery, especially in the presence of substantial left ventricular enlargement or dysfunction. Bacterial endocarditis, although less common than aortic stenosis and regurgitation, is associated with substantial morbidity and mortality. Electrocardiographically gated CT reliably demonstrates infectious vegetations and benign excrescences of 1 cm or more on the valve surface, allowing the assessment of any embolic complications.

Original languageEnglish (US)
Pages (from-to)1399-1420
Number of pages22
JournalRadiographics
Volume32
Issue number5
DOIs
StatePublished - Sep 2012

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Aortic Valve Insufficiency
Aortic Valve Stenosis
Aortic Valve
Pathologic Constriction
Magnetic Resonance Spectroscopy
Tomography
Cardiac Surgical Procedures
Magnetic Resonance Imaging
Ventricular Dysfunction
Bacterial Endocarditis
Doppler Ultrasonography
Peripheral Vascular Diseases
Endocarditis
Mitral Valve
Aorta
Dilatation
Coronary Vessels
Morbidity
Mortality
Incidence

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

CT and MR imaging of the aortic valve : Radiologic-pathologic correlation. / Bennett, Christopher J.; Maleszewski, Joseph; Araoz, Philip A.

In: Radiographics, Vol. 32, No. 5, 09.2012, p. 1399-1420.

Research output: Contribution to journalArticle

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