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Wk 10, Case 4 - Review

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Report

Patient History

74-year-old male with a history of aortic valve regurgitation with prior surgical aortic valve replacement (23 CE Magna 3000) with recent worsening symptoms of shortness of breath and evidence of bioprosthetic valve dysfunction by echocardiogram. Request for Cardiac CT 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).

Gating: Retrospective, ECG-gated helical cardiac volume (Variable Helical Pitch) transitioning to non-gated helical aorta and distal run-off acquisition

Cardiac cycle timing: 0-95%

Contrast type and volume: 60mL @ 4ml/sec then 30mL at 2.50mL/sec, 40mL saline at 4ml/sec

Complications: None

QC: Good signal noise

Artifacts: Mild motion artifact in the aortic root.

Findings:
Aortic Valve Findings:

Well-seated stented bioprosthetic valve (23 CE Magna 3000) without abnormal motion. Abnormal leaflet thickening with calcification of two leaflets (right coronary, noncoronary cusps) with moderate hypoattenuating leaflet thickening (HALT) of one leaflet (left coronary cusp). Leaflet hypoattenuation is affecting motion (HAM).

Aortic Annulus measurements:

Cardiac phase used quantification: 30%

Maximum diameter: 21.3 mm

Minimum diameter: 20.3 mm

Mean diameter: 20.7 mm

Area: 335 mm2

Perimeter: 65.1 mm

VIV TAVR measurements:

Coronary ostia are below stent posts.

Coronary ostia distance to virtual valve (Evolut Pro 26 mm):

Right: 5.05 mm.

Left: 6.38 mm.

Sinotubular junction distance to virtual valve: 1.94 mm (minimum).

Coronary ostia distance to virtual valve (Edwards S3 23 mm):

Right: 5.14 mm.

Left: 7.27 mm.

Coronary ostia height:

Right: 7.93mm (to annular plane)

Left: 4.78mm (to annular plane)

Optimum gantry angles:

3 cusp view: LAO 6, CAU9

Anterior view: RAO 0 CAU 15

No CRA-CAU view: LAO 15, CAU0

Cardiac Findings:

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

Chambers: Mildly dilated left ventricle. Normal systolic function with an estimated EF of 54%. Grossly normal right ventricle with normal systolic function. Moderately dilated left and right atria.

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 36.0 x 33.0 x 34.1 mm (sinus to sinus measurement).

The sinotubular junction measures 32.1 x 31.4 mm

The right sinus measures 18.2 mm in height.

The left sinus measures 16.00 mm in height.

The ascending aorta measures 35.8 x 35.8 mm.

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

2. Mildly dilated left ventricle with normal systolic function.

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

Acquired/Developmental

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