Vistasp Jimmy Daruwalla MD, Presenter: Nothing to Disclose

Preeti P. Kansal MD, Abstract Co-Author: Nothing to Disclose

Benjamin Freed, Abstract Co-Author: Nothing to Disclose

Daniel Lee, Abstract Co-Author: Research funded, CardiacAssist, Inc Spouse, Employee, Takeda Pharmaceutical Company Limited

James Christopher Carr MD, Abstract Co-Author: Research Grant, Astellas Group Research support, Siemens AG Speaker, Siemens AG Advisory Board, Guerbet SA

Chris Malaisrie, Abstract Co-Author: Consultant, Edwards Lifesciences Corporation Proctor, Edwards Lifesciences Corporation Speaker, Edwards Lifesciences Corporation Consultant, Baxter International Inc Speaker, ABIOMED, Inc Speaker, Werfen Life Group SAU

Jeremy Douglas Collins MD, Abstract Co-Author: Consultant, B. Braun Melsungen AG

Cardiac MRI (CMR) is highly accurate for pre-surgical classification of aortic valve morphology. Partial leaflet fusion, the forme frust lesion of a bicuspid aortic valve may be difficult to detect as this maintains a triangular valve orifice. The purpose of this study is to evaluate the impact of partial leaflet fusion of aortic valve morphologic classification at CMR compared to operative findings  

Retrospective analysis of consecutive 218 subjects referred for aortic surgery. All the subjects underwent pre-surgical imaging at 1.5T CMR. Subjects with history of aortic valve replacement or without dedicated aortic valve imaging were excluded. At surgery aortic valves were classified as bicuspid (BAV) or tricuspid (TAV). The studies were randomized and evaluated by an experienced cardiovascular radiologist. Balanced steady state free precession (bSSFP) and phase-contrast images were obtained at the level of the aortic valve. Images were reviewed for fusion of the commissures of the aortic valve. BAVs were categorized according to Siever’s classification. Partial or complete fusion and involved commissures were noted. The reader was blinded to the CMR study indication, other imaging findings, and operative results. The sensitivity, specificity, and accuracy for AoV classification at CMRI compared to operative findings. Misclassification rates for BAV and TAV were calculated, with subgroup analysis for complete and partial fusion BAVs

Five patients met at least one exclusion criteria, resulting in a cohort of 213 subjects. 82 and 131 subjects were classified as TAV and BAV at surgery respectively. All BAVs were correctly classified, including 58 subjects with partial fusion of at least one commissure (Table 1) . 6 (7.3%) TAVs were incorrectly classified as BAV at CMR; all 6 were thought to have a partial commissural fusion but were classified as TAV at surgery. The sensitivity, specificity, and accuracy for CMR classification was 100%, 92.7%, and 97.2% respectively

CMR is able to accurately characterize BAV morphology, including patients with varied degrees of partial leaflet fusion. Using standard bSSFP and phase-contrast sequences, TAVs are rarely misclassified as BAVs pre-operatively

Partial leaflet fusion, the forme frust of bicuspid aortic valve morphology, is easily identified at cardiac MRI using standard cine and phase contrast imaging sequences

Daruwalla, V, Kansal, P, Freed, B, Lee, D, Carr, J, Malaisrie, C, Collins, J, Evaluation of Aortic Valve Morphology at Cardiac MRI Compared to Operative Findings: Influence of Partial Leaflet Fusion on Accuracy of Pre-surgical Classification.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014506.html