Dilatation of the aorta in pure, severe, bicuspid aortic valve stenosis.

BACKGROUND: Aortic complications are more frequent after bicuspid aortic valve (BAV) replacement (AVR), than tricuspid aortic valve replacement. We studied the size of the proximal thoracic aorta in patients with BAV undergoing AVR for pure, severe aortic stenosis, looking for dilatation in comparison with patients with a matched tricuspid aortic valve (TAV) and normograms of aortic size. METHODS: Aortic root and ascending aortic diameter measurements were taken at 3 levels, from electrocardiographic-gated multidetector row computed tomograms, in 28 patients with pure, severe aortic stenosis before AVR. The patients were divided in 2 groups (BAV, n = 10; TAV, n = 18). Patients with greater than mild aortic regurgitation or who were scheduled for aortic root replacement were excluded. RESULTS: Although patients in the BAV group were younger (P <.0001) and less likely to have hypertension (P <.005), their aortic diameters were larger than those of patients in the TAV group at all levels measured (aortic sinus, 41.1 +/- 8.1 mm vs 33.8 +/- 3.3 mm; sino-tubular junction, 39.0 +/- 7.8 mm vs 31.1 +/- 3.8 mm; right pulmonary artery level, 42.8 +/- 7.1 mm vs 33.7 +/- 4.3 mm; P <.005 for all). Whereas 60% (6/10) of patients in the BAV group had >/=1 aortic diameter measurements greater than the 95th age-adjusted percentile, 0% (0/18) of patients in the TAV group did. CONCLUSIONS: Patients with BAV undergoing AVR with pure, severe aortic stenosis commonly have moderate dilatation of the thoracic aorta, whereas matched patients with a TAV do not. This finding may contribute to the increased frequency of aortic complications seen in follow up of patients with a BAV after AVR.

Thoracic aorta at multi-detector row CT: motion artifact with various reconstruction windows.

The authors assessed motion artifact of the thoracic aorta in 25 patients who underwent multi-detector row computed tomography (CT) with retrospective electrocardiographic (ECG) gating. CT reconstructions centered at four phases of diastole were compared for five different levels of the thoracic aorta. A significant positive correlation was observed between heart rate and motion artifact (r = 0.72, P <.001). The optimal reconstruction phase varied between patients, and this was directly related to heart rate. For patients with a heart rate of 70 beats per minute, the reconstruction phase centered at 75% of the R-R interval had the significantly least motion artifact (P =.004). Conversely, the optimal reconstruction phase for patients with heart rates above 70 beats per minute was centered at 50% of the R-R interval (P =.09).

Conservative management of contained coronary perforation after percutaneous intervention.

Contained perforation of the coronary artery may occur following coronary intervention and is generally managed aggressively with acute percutaneous or surgical intervention. We report a case of contained perforation following intervention on an occluded right coronary artery, leading to lumenal compression by perivascular hematoma and reduced distal flow. This was managed conservatively with an excellent clinical and angiographic outcome.