Multi-slice spiral CT imaging after surgical treatment of aortic coarctation

Excerpt

A 31-year old male patient presented for further workup of aortic root dilatation in the presence of a bicuspid aortic valve demonstrated in transthoracic echocardiography. Due to postductal aortic coarctation, a prosthetic graft of 8 mm diameter had been implanted to bypass the stenotic region at the age of 9 years. In addition, an aberrant right subclavian artery (arteria lusoria) was known to originate immediately distal to the coarctation. Invasive hemodynamics revealed a peak pressure gradient of 20 mmHg from the aortic arch to the descending aorta, but invasive angiography could not completely clarify the anatomy of the stenotic region. A multi-slice spiral CT study using a 16-slice scanner with 0.75 mm slice collimation and retrospectively ECG correlated reconstruction of images with 1.0 mm slice thickness was performed to simultaneously investigate both the region of aortic coarctation and the aortic root and ascending aorta. Along with the bicuspid and dysmorphic aortic valve, aortic root dilatation to a maximum diameter of 65 mm was demonstrated. Images reformatted in a para-axial plane revealed separate origins of the left anterior and left circumflex coronary artery (Fig. 1). In sagitally reformatted images and three-dimensional reconstructions, a patent graft with slight calcifications, as well as communication via the coarctation and a small diverticulum at the site of insertion of Botalli’s ligament were visualized (Figs. 2, 3). The patient was scheduled for elective aortic root replacement and positioning of a bypass graft from the ascending to the descending aorta.

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