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European Radiology
Published in: European Radiology 4/2015

01-04-2015 | Cardiac

Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

Authors: So Hyeon Bak, Sung Min Ko, Meong Gun Song, Je Kyoun Shin, Hyun Kun Chee, Jun Suk Kim

Published in: European Radiology | Issue 4/2015

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Abstract

Objective

The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices.

Methods

We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: 1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; 2) diameters of ascending and descending aorta, and main pulmonary artery; and 3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses.

Results

At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV.

Conclusion

CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS.

Key Points

• Accurate morphologic assessment of the aortic valve is important for treatment planning.
• It is difficult to differentiate BAV from TAV with a fused cusp.
• CCT provides diagnostic clues for the differentiation of BAV and TAV.
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Metadata
Title
Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion
Authors
So Hyeon Bak
Sung Min Ko
Meong Gun Song
Je Kyoun Shin
Hyun Kun Chee
Jun Suk Kim
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3494-1

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