Bicuspid aortic stenosis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Usama Talib, BSc, MD [3]

Overview

Computed tomography can be helpful as a diagnostic tool in conditions where the echocardiographic findings are inconclusive.

Cardiac CT

Bicuspid aortic valves are often associated with dilatation of the aortic root or ascending thoracic aorta, which can lead to aortic aneurysm or aortic dissection.[1][2] Visualization of mid aorta may be difficult with echocardiography and during such instances, MRI or CT are helpful to evaluate for aneurysm or dissection in aorta.[3]

ACC/AHA Guidelines for Cardiac CT in Patients with Bicuspid Aortic Valve[4]

Class I

1. Cardiac magnetic resonance imaging or cardiac computed tomography is indicated in patients with bicuspid aortic valves when morphology of the aortic root or ascending aorta cannot be assessed accurately by echocardiography. (Level of Evidence: C)

2. Patients with bicuspid aortic valves and dilatation of the aortic root or ascending aorta (diameter > 4.0 cm*) should undergo serial evaluation of aortic root/ascending aorta size and morphology by echocardiography, cardiac magnetic resonance, or computed tomography on a yearly basis. (Level of Evidence: C)

Class IIa

1. Cardiac magnetic resonance imaging or cardiac computed tomography is reasonable in patients with bicuspid aortic valves when aortic root dilatation is detected by echocardiography to further quantify severity of dilatation and involvement of the ascending aorta. (Level of Evidence: B)


*Consider lower threshold values for patients of small stature of either gender.

References

  1. Nistri S, Sorbo MD, Marin M, Palisi M, Scognamiglio R, Thiene G (1999). "Aortic root dilatation in young men with normally functioning bicuspid aortic valves". Heart (British Cardiac Society). 82 (1): 19–22. PMC 1729087. PMID 10377302. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)
  2. Niwa K, Perloff JK, Bhuta SM, Laks H, Drinkwater DC, Child JS, Miner PD (2001). "Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses". Circulation. 103 (3): 393–400. PMID 11157691. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)
  3. Isselbacher EM (2005). "Thoracic and abdominal aortic aneurysms". Circulation. 111 (6): 816–28. doi:10.1161/01.CIR.0000154569.08857.7A. PMID 15710776. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)
  4. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)

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