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Wk 10, Case 1 - Review

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Patient History

72-year-old male with severe aortic valve stenosis. Request for Cardiac CT and CT angiogram chest, abdomen and pelvis for pre-procedural evaluation.

Report
Procedure: Computed tomographic angiography, heart, coronary arteries, and thoracic, abdominal, and proximal peripheral arteries, with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) (CPT code: 75574).

Technique: TAVR CT cardiac and CT angiogram chest, abdomen, and pelvis.

Gating: Retrospective, ECG-gated helical cardiac volume transitioning to non-gated helical aorta and distal run-off acquisition

Cardiac cycle timing: 0-95%

Contrast type and volume: 60mL at 5ml/sec then 40mL at 2.50mL/sec, followed by 40mL saline at 2.5mL/sec

at 4ml/sec

Complications: None

QC: Good signal noise

Artifacts: None

Findings:
Morphology: Tricuspid aortic valve. Calcium distribution in the leaflets is symmetric involving the leaflet margins and base of the leaflets. The estimated AVA is 85.3 mm2 by 3D planimetry.

LVOT calcification: None.

Aortic Annulus measurements:

Cardiac phase used quantification: 35%

Maximum diameter: 23.8 mm

Minimum diameter: 19.9 mm

Mean diameter: 27.8 mm

Area: 382 mm2

Perimeter: 70 mm

Coronary ostia height:

Right: 20.4 mm (to annular plane)

Left: 19.3 mm (to annular plane)

Optimum gantry angles:

3 cusp view: RAO 2, CAU 3

Anterior view: RAO 0, CAU 43

No CRA- CAU view: LAO 29 CAU 0

Cardiac Findings:

Coronary Arteries: Normal coronary origins with a large amount of calcified and non calcified plaque in a multivessel distribution. This study was not optimized for the assessment of the coronary arteries.

Chambers: Left atrial size is dilated in size with no left atrial appendage filling defect. The left and right ventricular cavity sizes are within normal limits. There are no abnormal filling defects. Normal left ventricular systolic function with an estimated EF of 72% with no regional wall motion abnormalities.

Myocardium: Increased wall thickness in concentric hypertrophy pattern. No outpouching or masses.

Pericardium: Normal thickness with no significant effusion or calcium present.

Pulmonary arteries: Normal in size without proximal filling defect. Not fully opacified.

Pulmonary veins: Normal pulmonary venous drainage. There were four noted pulmonary veins, two on the right and two on the left.

Aortoiliac Evaluation:

Cardiac phase used for evaluation 75%

Thoracic Aorta:

The aortic root measures 29.4 x 28 x 27.7 mm (sinus to sinus measurement).

The sinotubular junction has a minimum diameter of 27.9 mm

The ascending aorta is dilated measuring 41.3 mm with a minimum diameter of 38.1mm

There is a three-vessel arch with minimum diameter of 24.3 mm.

The descending aorta has a minimum diameter of at 22.0 mm.

The left subclavian has a minimum diameter of 7.17 mm.

There is extensive atherosclerotic disease throughout the thoracic aorta and its branches. No significant tortuosity but the thoracic aorta, aortic arch, and descending thoracic aorta are dilated.

Abdominal Aorta:

The abdominal aorta has a minimum diameter of 14.3 mm

There is no evidence of significant tortuosity. There is no intraluminal obstruction or thrombi. The celiac axis, SMA, and IMA are patent. There are single renal arteries bilaterally that are patent. There is diffuse calcific atherosclerotic disease throughout the abdominal aorta.

Iliofemoral arteries:

The right common iliac has a minimum diameter of 9.47 mm.

The right external iliac has a minimum diameter of 6.77 mm.

The right common femoral has a minimum diameter of 8.90 mm.

There is no calcification in the RCFA. The femoral head is located at the upper third the vessel.

The left common iliac has a minimum diameter of 9.97 mm

The left external iliac has a minimum diameter of 6.84 mm

The left common femoral has a minimum diameter of 8.69 mm.

There is no calcification in the LCFA. The femoral head is located at the upper third of the vessel.

Impressions
1. Aortic annular, root and valve measurements as above.

2. Overall, there is a large amount of plaque in the coronary arteries.

3. Aortoiliac measurements as above.

Case Discussion

Faculty

Giovanni E. Lorenz, DO

Cardiothoracic Radiologist

San Antonio Military Health System (SAMHS)

Emilio Fentanes, MD

Director of Cardiac Imaging, Department of Cardiology

Brooke Army Medical Center

Tags

Vascular

Cardiac valves

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

CTA

Acquired/Developmental

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