Aortic stenosis CT

Resident Survival Guide

Aortic Stenosis Microchapters
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Aortic Valve Area Calculation
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Transcatheter Aortic Valve Replacement (TAVR) TAVR vs SAVR Critical Pathway Patient Selection Imaging Evaluation Valve Types TAVR Procedure Post TAVR management AHA/ACC Guideline Recommendations
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, MBBS [2]; Mohammed A. Sbeih, M.D. [3]; Usama Talib, BSc, MD [4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]

Overview

Computed tomography can be helpful as a diagnostic tool in conditions where the echocardiographic findings are inconclusive.

CT Scan

Shown below is the plain CT of a patient with supravalvular aortic stenosis. The image shows an almost circular supravalvular aortic calcification of the aortic wall with extension of calcifications into the left main stem. The area of calcification is shown in yellow.

Advantages

Following are a few advantages of the use of CT in Aortic Stenosis.

• CT scan provides additional anatomic details compared to echocardiography.
• It may allow quantitattion of chamber sizes and calcification of the aortic valve.
• The presence of calcification is a marker of hemodynamic severity, particularly in the younger patient.
• It is done faster compared to MRI, thus avoiding the need for anesthesia in small children.

Disadvantages

• CT scan is costly.
• Radiation can have long terms side-effect on growing children.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Recommendations for Diagnostic Testing: Initial Diagnosis of AS Referenced studies that support the recommendations are summarized in Online Data Supplement

Class IIa

5.   In patients with suspected low-flow, low-gradient severe AS with normal or reduced LVEF (Stages D2 and D3), measurement of aortic valve calcium score by CT imaging is reasonable to further define severity.(Level of Evidence: B-NR)