8 Sinus of Valsalva Aneurysm with AR
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a
S.M. Ko
b
c
Fig. 17.10 QAV with central AR. (a–c) Oblique axial images obtained
during mid-systole (a) and mid-diastole (b) (http://extras.springer.
com/2015/978-3-642-36396-2) show quadricuspid aortic valve with cen-
tral coaptation defect (arrow). (c) (http://extras.springer.com/2015/9783-642-36396-2) b-SSFP cardiac MR image obtained during diastole
demonstrates a central regurgitant jet (arrowhead) below the aortic valve
• Nonruptured aneurysms are usually asymptomatic, and
symptoms are related to aneurysm rupture or mass effect
on adjacent cardiac structures.
• AR is a common (30–50 % of patients) complication of
both nonruptured and ruptured aneurysm of the sinus of
Valsalva.
• Cardiac CT and MRI provide accurate assessment of the
origin and size of Valsalva sinus aneurysms, complications (AR, aortocardiac shunt, right ventricular outflow
tract obstruction) and surrounding cardiac structures
(Fig. 17.11) [12].
17.9
Degenerative Aortic Stenosis
• Progressive dystrophic calcification and sclerotic thickening of the aortic valve cusps, leading to asymmetrically
reduced motion and opening of the valve.
• No commissural fusion.
• Accompanied by calcification of the mitral annulus and
coronary arteries.
• Aortic valve calcification is associated with the presence
and greater extent of coronary artery plaque burden
(calcified and mixed plaque) (Fig. 17.12) [1].
17
Aortic Valvular Heart Disease
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b
Fig. 17.11 Example of sinus Valsalva aneurysm with AR. (a, b).
Oblique axial image obtained during mid-systole (a) (http://extras.
springer.com/2015/978-3-642-36396-2) shows a sinus Valsalva aneurysm involving the right coronary sinus (*) and central coaptation
a
defect (arrow). (b) (http://extras.springer.com/2015/978-3-642-36396-2)
b-SSFP cardiac MR image obtained during diastole demonstrates a
central regurgitant jet (arrowhead) below the aortic valve
b
Fig. 17.12 Degenerative AS. (a, b) Oblique axial image obtained during mid-systole (a) and thick-slab volumetric reconstruction (b) image show
an opening limitation of the aortic valve with dense leaflet calcification (gray color in the volumetric reconstruction image)
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a
S.M. Ko
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Fig. 17.13 Rheumatic AS. (a, b) Oblique axial images obtained during mid-systole (a) and mid-diastole (b) show a commissural fusion (arrow)
between noncoronary and left coronary cusps. All valvular leaflets were diffusely thickened with minimal calcification
17.10 Rheumatic Aortic Valve Disease
• One or more of the three commissures are often fused,
and the cusps may be either focally or diffusely fibrotic
with or without commissural fusion or calcification.
• Invariably accompanied with rheumatic mitral valve disease.
• Stenosis, regurgitation, or a combination of the two
(Fig. 17.13) [1].
17.11 Annuloaortic Ectasia with Aortic
Regurgitation
• Cystic medial necrosis
• Progressive aortic root dilatation and hemodynamically
significant severe AR
• Aortic root dissection or rupture
• Marfan syndrome (60–80 %) and idiopathic (30 %)
• Starts with dilatation of the aortic sinuses and progresses
into the sinotubular junction and ultimately into the aortic
annulus
• AR complicates subarterial VSDs about five times more
common than perimembranous VSDs [13].
17.13 Aortic Valve Involvement in Behỗet
Disease
A very rare but life-threatening cardiovascular complication and misdiagnosed as infective endocarditis.
• Aortitis involving aortic root and aortic valve, leading to
aortic regurgitation which might be associated with valvulitis, aneurysm of the sinus of Valsalva, and prolapse
and perforation of the aortic valve.
• The frequency of postoperative complications, such as
prosthetic valve dehiscence or periprosthetic leakage, is
higher in patients with Behỗet disease than in patients
with Takayasus arteritis.
Cardiac CT is helpful for detecting pseudoaneurysm and
vegetation-like mass and postoperative complications
(Fig. 17.14) [14].
17.14 Infective Endocarditis
17.12 Aortic Valve Prolapse and Aortic
Regurgitation Associated
with Ventricular Septal Defect
• Aortic valve prolapse (AVP), mainly the right coronary
cusp prolapse, and aortic regurgitation can occur in a
subset of patients with a ventricular septal defect (VSD).
• The most acceptable mechanism of AVP is the Venturi effect.
• Aortic valve is involved in about 1/2 of cases.
• Infectious vegetations or nodular excrescences that form
on the valve cusps, most commonly on the ventricular
surface of the cusps, sometimes lead to embolism.
• Local complications: vegetation, cusp perforation, aneurysm, annular abscess, fistula, chordal rupture, perivalvular abscess, and pseudoaneurysm.
17
Aortic Valvular Heart Disease
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a
b
Fig. 17.14 Behỗets disease involving the aortic root with pseudoaneurysm formation. (a, b) Oblique axial images obtained during midsystole (a) and oblique sagittal image (b) show a large and multilobulated
a
pseudoaneurysm formation (arrows) around a prosthetic aortic valve in
patient with Behỗets disease. There were large paravalvular dehiscence
(arrowhead) between the prosthetic aortic valve and the aortic annulus
b
Fig. 17.15 Infective endocarditis involving the aortic valve. (a, b) Oblique sagittal image (a) and oblique axial image (b) obtained during midsystole show a large vegetation (arrow) attached left coronary cusp and right coronary cusp in patient with infective endocarditis
• Healed endocarditis: indentation of the cusp free margin,
cusp perforation, aneurysm, ruptured chordae tendineae,
and healed fistula.
• Cardiac CT: high diagnostic accuracy for vegetation,
paravalvular abscess, and pseudoaneurysm compared
with transesophageal echocardiography and depiction of
other infectious complications such as septic pulmonary
emboli and renal infarction (Fig. 17.15) [15].
17.15 Native Aortic Valve Thrombosis
• A rare event associated with aortic valve disease, heart
valve replacement, a hypercoagulable state, infective
endocarditis, or an autoimmune disease.
• Clinical importance – embolic event and differential diagnosis of aortic valve mass [16]
