Chapters authored
Use of Computed Tomography in the Assessment of Severity of Aortic Valve Stenosis
The workhorse in the diagnosis of aortic stenosis (AS) has been transthoracic echocardiography (TTE) with clear-cut validated threshold values for grading it mild, moderate, or severe. However, up to one-third of patients may present with discordant findings on echo sonogram and may need further evaluation with other imaging modalities such as computed tomography (CT). CT is useful in determining aortic valve area (AVA) by planimetry and outperforms TTE in identifying severe AS in bicuspid aortic valve (BAV), but it is not routinely ordered for those purposes. It has been widely used in helping, determining, and grading the severity of AS by calculating aortic valve calcium (AVC) load with a scoring system. AVC scores of 2000 AU or more for men and 1300 AU for women are highly indicative of severe AS and have been associated with the poor outcomes. AVC score will underestimate AS in a minority of circumstances where the process is driven more by fibrosis than calcification. CT use is limited by its recent adoption into medical practice and, therefore, is still not universally available in every center. It requires additional training for providers and low-dose radiation exposure may be a concern for some patients.
Part of the book: Aortic Stenosis