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Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.

Karlsberg DW, Elad Y, Kass RM, Karlsberg RP - Clin Med Insights Cardiol (2012)

Bottom Line: A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency.Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement.The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.

View Article: PubMed Central - PubMed

Affiliation: Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.

ABSTRACT
A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.

No MeSH data available.


Related in: MedlinePlus

(A and Movie 1) Short axis echocardiographic image of the quadricuspid aortic valve with movie. (B and Movie 2) Transesophageal image of the quadricuspid aortic valve with movie. (C) Normal left anterior descending, circumflex and right coronary arteries obviating the need for invasive coronary angiography.
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f1-cmc-6-2012-041: (A and Movie 1) Short axis echocardiographic image of the quadricuspid aortic valve with movie. (B and Movie 2) Transesophageal image of the quadricuspid aortic valve with movie. (C) Normal left anterior descending, circumflex and right coronary arteries obviating the need for invasive coronary angiography.

Mentions: A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Transthoracic echocardiography showed severe aortic regurgitation and a quadricuspid aortic valve (Fig. 1A, Movie 1). A transesophageal echocardiogram was performed to better define the quadricuspid aortic valve (Fig. 1B Movie 2). In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Coronary arteries were normal with no calcified or non-calcified plaque (Fig. 1C). Cardiac CT revealed a type E quadricuspid1 or Type III2 (“four-leaf clover”) aortic valve, with three cusps of similar size and one smaller cusp. Cardiac CT also showed lack of co-adaption of the valve in diastole indicative, of aortic insufficiency (Fig. 2A and B, Movie 3). Advanced computing algorithmic software was performed. These images were created using a non-rigid registration based algorithm which matched the boundaries of the phases from areas of interest over time thus accounting for the hearts continuous deforming movements during the cardiac cycle. This technology may more accurately reflect true cardiac movement non-invasively. This technique tracks the movement of individual voxels through space and time in an attempt to reduce noise, improve motion coherence and functional analytics (Ziosoft Inc, USA)3 (Fig. 2C, Movie 4). Surgical photographs and in-vitro anatomic pathology exam confirmed the findings (Fig. 2D).


Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.

Karlsberg DW, Elad Y, Kass RM, Karlsberg RP - Clin Med Insights Cardiol (2012)

(A and Movie 1) Short axis echocardiographic image of the quadricuspid aortic valve with movie. (B and Movie 2) Transesophageal image of the quadricuspid aortic valve with movie. (C) Normal left anterior descending, circumflex and right coronary arteries obviating the need for invasive coronary angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303489&req=5

f1-cmc-6-2012-041: (A and Movie 1) Short axis echocardiographic image of the quadricuspid aortic valve with movie. (B and Movie 2) Transesophageal image of the quadricuspid aortic valve with movie. (C) Normal left anterior descending, circumflex and right coronary arteries obviating the need for invasive coronary angiography.
Mentions: A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Transthoracic echocardiography showed severe aortic regurgitation and a quadricuspid aortic valve (Fig. 1A, Movie 1). A transesophageal echocardiogram was performed to better define the quadricuspid aortic valve (Fig. 1B Movie 2). In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Coronary arteries were normal with no calcified or non-calcified plaque (Fig. 1C). Cardiac CT revealed a type E quadricuspid1 or Type III2 (“four-leaf clover”) aortic valve, with three cusps of similar size and one smaller cusp. Cardiac CT also showed lack of co-adaption of the valve in diastole indicative, of aortic insufficiency (Fig. 2A and B, Movie 3). Advanced computing algorithmic software was performed. These images were created using a non-rigid registration based algorithm which matched the boundaries of the phases from areas of interest over time thus accounting for the hearts continuous deforming movements during the cardiac cycle. This technology may more accurately reflect true cardiac movement non-invasively. This technique tracks the movement of individual voxels through space and time in an attempt to reduce noise, improve motion coherence and functional analytics (Ziosoft Inc, USA)3 (Fig. 2C, Movie 4). Surgical photographs and in-vitro anatomic pathology exam confirmed the findings (Fig. 2D).

Bottom Line: A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency.Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement.The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.

View Article: PubMed Central - PubMed

Affiliation: Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.

ABSTRACT
A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.

No MeSH data available.


Related in: MedlinePlus