Gudrun Feuchtner MD, Presenter: Nothing to Disclose

Daniel Junker, Abstract Co-Author: Nothing to Disclose

Andrea Klauser MD, Abstract Co-Author: Nothing to Disclose

Peter Franz Walter Soegner MD, Abstract Co-Author: Nothing to Disclose

Florian Wolf MD, Abstract Co-Author: Nothing to Disclose

Johannes Bonatti MD, Abstract Co-Author: Nothing to Disclose

Thomas Schachner MD, Abstract Co-Author: Nothing to Disclose

Corinna Velik-Salchner, Abstract Co-Author: Nothing to Disclose

Dieter Zur Nedden MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

to compare evaluation of 4-D valve morphology and aortic root dimensions before valve surgery by 64-slice computed tomography (CT) with the diagnostic standard transesophageal echocardiography (TEE) and with intraoperative findings regarding pre-surgical planning.

22 patients were examined with multidetector CT (64x0.6mm;0.33s;120kV/900mAs,100ml Iomeron400™,Bracco;5ml/s;ECG-gated image reconstruction at 10% steps during cardiac cycle) 1 day before valve surgery. The cardiac surgeon graduated CT-findings as “major” (main technique influenced);“minor” (intraoperative steps);“non-relevant”.

Aortic root measurements by CT were significantly correlated with TEE: anulus 3.2 vs 2.8cm (p=0.02); max. sinus valsalva 4.1 vs 3.9cm (p=0.002); sinu-tubular juction 3.6 vs 3.7cm (p<0.001). Aortic valve morphology (tricuspid vs bicuspid) could be identified by CT with a good agreement (92%) to the intraoperative (OP) specimen;but by TEE 3/7(43.5%) OP-confirmed bicuspid valves were missed. Anulus calcium was correctly diagnosed by CT with 100% agreement to OP but TEE missed 33.3%. Both valve morphology and aortic root analysis by CT could clarify the main surgical technique in 5/5 (100%) patients with aortic regurgitation (+/-aortic dilatation)(e.g.Bentall vs. David-OP). In 3/7 pts (43.5%) with endocarditis, CT added relevant information to the TEE (e.g. extent of paravalvular abscess) and CT correctly detected 6/7 (86%) vegetations; 1 cusp perforation was missed. Value of CT was “minor” in 4 pts with aortic stenosis (e.g.cannulation site) but "major" only in 2 pts.

64-slice CT allows accurate evaluation of aortic valve and aortic root morphology (superior to TEE) and dimensions (equally to TEE) which provides sustantial information for pre-surgical planning in patients with aortic regurgitation (+/- aortic root dilatation) influencing the main surgical technique. CT can also provide additive relevant information to TEE in selected patients with endocarditis.

Comprehensive valve and aortic root evaluation by 64-slice CT is accurate and could replace TEE before valve surgery in selected patients referred to CT coronary angiography.

Feuchtner, G, Junker, D, Klauser, A, Soegner, P, Wolf, F, Bonatti, J, Schachner, T, Velik-Salchner, C, Zur Nedden, D, et al, , et al, , Is 64-slice Cardiac Computed Tomography Useful for Presurgical Planning before Valve Surgery?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013556.html