[Use of cardiovascular magnetic resonance (CMR) in preoperative assessment of aortic stenosis—case report]

Mieczysław Pasowicz, Piotr Klimeczek, Ewa Wicher-Muniak, Renata Kolasa-Trela, Piotr Podolec, Wiesława Tracz, Jerzy Sadowski
Przegla̧d Lekarski 2004, 61 (6): 596-9

PURPOSE: CMR is a helpful additional diagnostic method in cardiac imaging. Thanks to high spatial and temporal resolution and high quality of obtained images this method is used in patients with poor echocardiographic acoustic window. We present a case of a patient, in whom CMR was conclusive as a non-invasive method of aortic valve stenosis assessment before qualification to cardiosurgery.

METHODS: CMR was performed in a 70-year-old female A. C. who was under cardiological control due to symptomatic aortic stenosis. Because of difficulties in echocardiographic examinations (TTE) the aortic valve area was impossible to evaluate and aortic gradient value was difficult to assess and it differed in consecutive TTE performed over a short period (maximal gradient: 66-91 mmHg; mean gradient: 37-50 mmHg). The patient underwent CMR (Magnetom Vision Plus 1.5 T, Siemens) with the use of cine gradient echo sequences which made possible morphological and functional assessment of the valve and left ventricle. LV mass indices, IVS thickness, EF, aortic valve area, maximal aortic valve gradient were measured.

RESULTS: CMR revealed: left ventricle muscle hypertrophy (IVS--1.8 cm; LV mass index--210 g/m2), EF--70%, no regional contractility disturbances and aortic valve area less than 1 cm2. In aortic valve and anulus extensive calcifications were visualised as low intensity signal area. Turbulent flow through aortic valve was found, maximal gradient about 64 mmHg. On the basis of all clinical symptoms and measurements based on imaging methods, the patient was qualified for cardiosurgery which was held in the Department of Cardiovascular Surgery and Transplantology. Coronary angiography revealed no significant stenosis. The operation was performed in extracorporeal circulation, general hypothermia and cardioplegia. Calcified aortic valve leaflets were excised and replaced by artificial valve (St. Jude Medical 21A Masters). The patient is in good health and was discharged.

CONCLUSIONS: CMR is a valuable non invasive imaging method complementary to TTE in morphological and functional assessment of aortic valve and left ventricle, especially in patients with poor acoustic window in TTE.

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