Gee Hyun Kim, Presenter: Nothing to Disclose

Sung Min Ko, Abstract Co-Author: Nothing to Disclose

Meong Gun Song, Abstract Co-Author: Nothing to Disclose

To assess usefulness of comprehensive cardiac CT study to investigate the BAV morphology and the associated valvular and ascending aorta abnormalities.

This retrospective study included 250 patients (66 women, mean age 51.6±14.6 years) diagnosed BAV based on CT or surgical findings. All patients underwent both transthoracic echocardiography (TTE) and CT. BAV morphology was classified according to the Sievers terminology (cusp oritentation and presence or absence of a raphe). Planimetric measurements of aortic valve area (AVA) and regurgitant orifice area (ROA) on CT were compared with TTE. The ascending aortic dimensions were measured by CT at four different levels (annulus, sinuses of Valsalva, sinotubular junction, and tubular portion). The ascending aorta was assigned to normal, dilated mid-ascending, dilated root, and combined dilated root and mid-ascending type according to the segment of the aorta predominantly involved in dilatation (diameter>4 cm).

BAV phenotype and presence of a raphe on CT were accurate with operative findings in 197 of 208 patients (94.7%). Anterior-posterior orientation of BAV was present in 155 (62%) and raphe in 151(60.4%) patients. There was excellent agreement (κ=0.84) between CT and TTE for detecting valve dysfunction (n=237). CT detected 78 of 84 (92.8%) patients with aortic regurgitation, 77 of 78 (98.7%) patients with aortic stenosis, and 47 of 75 (62.6%) patients with combined stenosis and regurgitation. CT-derived AVA (1.07±0.35 cm2) correlated well (r=0.78) with TTE-derived (0.90±0.33 cm2). Quantification of ROA by CT (0.61±0.59 cm2) was correlated well with the grade of aortic regurgitation by TTE (r=0.70). Seventy (28%) patients had a normal aorta type, 72 (29%) had the mid-ascending type, 32 (13%) had the dilated root type, and 76 (30%) had the combined dilated root and mid-ascending type. Aortic regurgitation was frequently accompanied with normal, dilated root, and combined types, aortic stenosis with normal and mid-ascending types, combined aortic stenosis and regurgitation with mid-ascending and combined types. Aortic dilatation was found in 9 (69%) patients with normal valve function.

CT allows comprehensive assessment of valvular morphology, phenotype, and function and ascending aorta morphology in patients with BAV.

Comprehensive assessment of bicuspid aortic valve (BAV) provided by CT is valuable for treatment decision-making.

Kim, G, Ko, S, Song, M, Usefulness of Cardiac CT for Comprehensive Assessment of Bicuspid Aortic Valves: A comparison with Transthoracic Echocardiography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045775.html