Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT

Abstract

Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.

MUGA scan of apicoaortic conduit with incidental finding of pseudoaneurysm and repeat scan after aneurysmectomy

“…[ 3 ] Another complication is stenosis or occlusion of the AAC,[ 6 ] which we assessed in our patient. Previous imaging investigations, such as with cardiac magnetic resonance imaging (MRI) and multidetector CT, have shown predictable blood flow patterns between the native valve and the conduit,[ 8 9 ] which is associated with normal ventricular volumes and function, and good blood flow through the conduit. To the best of our knowledge, this is the first time an AAC has been imaged with a MUGA scan.…”

Subepicardial aneurysm after apicoaortic bypass

“…Bleeding and the formation of a pseudoaneurysm are some of the common and characteristic morbidities of apicoaortic bypass. [2][3][4] There have been reports of pseudoaneurysm after apicoaortic bypass, but little has been said about its cause. In the present case the coring site was probably too close to the septum, making some of the stitches on the septal margin unable to reach the endocardium, damaging the septal muscles, and resulting in a subepicardial aneurysm.…”

Apicoaortic Conduits

“…Cine loops, when available, also display leaflet motion. 38 LV function and morphology are assessed and compared with previous examinations. MDCT is incapable of directly measuring conduit flow or gradients, and therefore quantitative apicoaortic conduit functional analysis requires alternative modalities.…”