Aortic valve bypass surgery in severe aortic valve stenosis: Insights from cardiac and brain magnetic resonance imaging

Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study

Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA_cmr), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging.

Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA_cmr; (ii) geometric orifice area (GOA_cmr) by direct CMR planimetry; (iii) EOA_echo by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOA_hybrid) obtained by substituting CMR LVOT area into Doppler continuity equation.

Results: There was excellent pairwise positive linear correlation among AOA_cmr, EOA_hybrid, GOA_cmr, and EOA_echo (p < 0.001); AOA_cmr had the highest correlation with EOA_hybrid (R² = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA_cmr and EOA_hybrid. AOA_cmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively).

Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.

Aortic valve bypass for high-risk patients with symptomatic aortic stenosis: A case report

There are a significant number of symptomatic aortic stenosis (AS) patients not referred to the traditional methods for some complex conditions. We described a case of a 61‐year‐old female with severe symptomatic AS, calcific small aortic annulus (16.6 mm), narrow porcelain ascending aorta (aortic root: 14.6 mm, internal diameter: 14.0 mm), chronic renal insufficiency, and a history of the previous sternotomy for mechanical mitral valve replacement and coronary artery bypass grafting who underwent aortic valve bypass (AVB) with favorable results. AVB has been proposed as a complementary to surgery operation of aortic valve replacement and transcatheter aortic valve implantation in high‐risk AS patients.

Transcatheter Restoration of the Left Ventricular Outlet in a Patient With an Implanted Apicoaortic Conduit

We describe the transcatheter management of severe aortic regurgitation in a middle-aged patient with a porcelain aorta who underwent implantation of an apicoaortic valved conduit 12 years ago. Instantaneous relief of heart failure symptoms was achieved by restoring antegrade blood flow to the ascending aorta. (Level of Difficulty: Advanced.)