Pre-procedural multi-slice computed tomography (MSCT) in aortic valve replacement. Important measurements

PurposeTo describe the preoperative role of MSCT in aortic valve lesions regarding detection of valve morphological changes and important measurements needed for valve replacement.Subjects and methodsThis was a prospective study included 24 patients their mean age 53.4 years, with known aortic valve stenosis (AS) or regurgitation (AR) over a study period 1 year. All patients underwent CT angiography using 128 MSCT. The coronary angiography was done by means of a bolus tracking technique. Measurements were conventionally made from an “optimized” sagittal oblique left ventricular outflow tract (LVOT) reconstruction.ResultsThe most common cause for aortic valve lesion was degenerative (63%). Echocardiography (ECHO) and MSCT had highly statistically significant kappa agreement in differentiating AS and AR. The mean aortic valve area (AVA) in AS and AR were (1.2 ± 0.5 and 3.8 ± 0.3 cm²) with p value (0.000⁷). Aortic valve dimension at sinus of valsalva were (3.5 ± 0.2 & 4.6 ± 0.7 cm) in AS and AR respectively. At the sino-tubular junction (STJ) were (3.1 ± 0.2 & 4.4 ± 1.4) in AS and AR respectively. The mean aortic annulus area was (5.7 ± 1.3 cm²) in AS and (6.6 ± 0.8 cm²) in AR. MSCT was more significant than ECHO in detection and grading of calcification (p value < 0.01). The distance from the aortic annulus to the ostia of the left and the right coronary arteries were (1.8 ± 0.3 cm) and (1.6 ± 0.3 cm) respectively. Concomitant coronary atherosclerosis and >50% attenuated lumen was detected in (25% &12.5%) of our patients respectively.ConclusionThe familiarity with the MSCT features of aortic valve and using various measurements are considered to be helpful for the accurate diagnosis and proper pre-operative valve replacement preparation.