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Introduction: A pre-operative assessment of aortic valve anatomy is important in valve repair for aortic regurgitation (AR). Although echocardiogram provides precise information, clear visualization of entire aortic valve and accurate quantification of valve geometry are limited even with 3D transesophageal echocardiography. In this study, usefulness of cardiac computed tomography (CT) in the evaluation of aortic valve pathology was investigated. Methods: A total of 119 patients who underwent surgical treatment for severe AR from May 2016 to July 2021 and had preoperative CT were studied. From the CT data set, volume rendering movie image was reconstructed to visualize valve anatomy. Effective height (EH) and geometric height (GH) were measured by CT in diastole and compared to intraoperative measurements. Results: The quality of CT image was satisfactory in 100 patients (84%), acceptable in 17 patients (14%) and suboptimal in 2 patients (2%). CT could visualize such detailed anatomy as shown in the Figure. EH in 41 patients and GH in 67 were measured by both CT and surgery. The measurements showed a correlation in EH (r=0.79, p<0.0001) and in GH (r=0.74, p<0.0001) with minimal bias of -1.6 mm in EH and 0.4 mm in GH and narrow limits of agreement from -5.9 to2.6 mm in EH and from -3.7 to 4.6 mm in GH. Inter- observer variabilities in CT measurement of EH and GH were 3.8±2.9% and 2.6±1.8%, with interclass correlation coefficients of 0.997 and 0.980, respectively. Conclusions: Reproducibility of CT measurement was excellent, while there was a little discrepancy between CT and surgical measurement. Not all cases underwent intraoperative measurement, and cases with structurally complexity tended to have surgical measurement. Some errors may be included in also intraoperative measurements. CT feasibly visualized aortic valve en-face view with showing the etiology of AR, which gave useful information to surgeons who perform aortic valve repair.

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We report an extremely rare case of renal cell carcinoma(RCC)extending into the left atrium through the pulmonary vein next to lung metastasis. The patient was a 76-year-old man. Extirpation of the RCC in the right kidney was carried out. Metastasis to the lungs, mediastinal lymph nodes and the pubis were diagnosed and 4 years later, a myxoma-like tumor was formed in the left atrium by echocardiography. We extirpated of the tumor. During surgery, continuity with the metastatic lesion in the right lung, right inferior pulmonary vein and the left atrium was suggested. Histopathologic examination showed the same histopathology as seen in the RCC.

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