Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography

  • Song, Inyoung (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Park, Jung Ah (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Choi, Bo Hwa (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Ko, Sung Min (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Shin, Je Kyoun (Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Chee, Hyun Keun (Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Jun Seok (Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Received : 2015.11.21
  • Accepted : 2016.04.12
  • Published : 2016.07.01
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Abstract

Objective: The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods: We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results: All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion: Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.

Keywords

Acknowledgement

Supported by : Konkuk University

References

  1. Feldman BJ, Khandheria BK, Warnes CA, Seward JB, Taylor CL, Tajik AJ. Incidence, description and functional assessment of isolated quadricuspid aortic valves. Am J Cardiol 1990;65:937-938 https://doi.org/10.1016/0002-9149(90)91446-D
  2. Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol 1973;31:623-626 https://doi.org/10.1016/0002-9149(73)90332-9
  3. Tutarel O. The quadricuspid aortic valve: a comprehensive review. J Heart Valve Dis 2004;13:534-537
  4. Jagannath AD, Johri AM, Liberthson R, Larobina M, Passeri J, Tighe D, et al. Quadricuspid aortic valve: a report of 12 cases and a review of the literature. Echocardiography 2011;28:1035-1040 https://doi.org/10.1111/j.1540-8175.2011.01477.x
  5. Formica F, Sangalli F, Ferro O, Paolini G. A rare cause of severe aortic regurgitation: quadricuspid aortic valve. Interact Cardiovasc Thorac Surg 2004;3:672-674 https://doi.org/10.1016/j.icvts.2004.08.004
  6. Godefroid O, Colles P, Vercauteren S, Louagie Y, Marchandise B. Quadricuspid aortic valve: a rare etiology of aortic regurgitation. Eur J Echocardiogr 2006;7:168-170 https://doi.org/10.1016/j.euje.2005.03.011
  7. Janssens U, Klues HG, Hanrath P. Congenital quadricuspid aortic valve anomaly associated with hypertrophic non-obstructive cardiomyopathy: a case report and review of the literature. Heart 1997;78:83-87 https://doi.org/10.1136/hrt.78.1.83
  8. Timperley J, Milner R, Marshall AJ, Gilbert TJ. Quadricuspid aortic valves. Clin Cardiol 2002;25:548-552 https://doi.org/10.1002/clc.4950251203
  9. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118:e523-e661 https://doi.org/10.1161/CIRCULATIONAHA.108.190748
  10. Jeon MH, Choe YH, Cho SJ, Park SW, Park PW, Oh JK. Planimetric measurement of the regurgitant orifice area using multidetector CT for aortic regurgitation: a comparison with the use of echocardiography. Korean J Radiol 2010;11:169-177 https://doi.org/10.3348/kjr.2010.11.2.169
  11. LaBounty TM, Sundaram B, Agarwal P, Armstrong WA, Kazerooni EA, Yamada E. Aortic valve area on 64-MDCT correlates with transesophageal echocardiography in aortic stenosis. AJR Am J Roentgenol 2008;191:1652-1658 https://doi.org/10.2214/AJR.07.3703
  12. Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ; Korean Society of Radiology; Korean Society of Cardiology. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015;16:251-285 https://doi.org/10.3348/kjr.2015.16.2.251
  13. Li X, Tang L, Zhou L, Duan Y, Yanhui S, Yang R, et al. Aortic valves stenosis and regurgitation: assessment with dual source computed tomography. Int J Cardiovasc Imaging 2009;25:591-600 https://doi.org/10.1007/s10554-009-9456-z
  14. Jacobs JE, Srichai M, Kim D, Hecht E, Kronzon I. Quadricuspid aortic valve: imaging findings on multidetector helical CT with echocardiographic correlation. J Comput Assist Tomogr 2006;30:569-571 https://doi.org/10.1097/00004728-200607000-00003
  15. Wang N, Zhang C, Zhang Z, Chen B, Du F. Quadricuspid aortic valve with anomalous coronary artery: comprehensive evaluation with multidetector computed tomography. Tex Heart Inst J 2012;39:303-305
  16. Willmann JK, Weishaupt D, Lachat M, Kobza R, Roos JE, Seifert B, et al. Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis. Radiology 2002;225:120-128 https://doi.org/10.1148/radiol.2251011703
  17. Bak SH, Ko SM, Song MG, Shin JK, Chee HK, Kim JS. Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion. Eur Radiol 2015;25:1208-1217 https://doi.org/10.1007/s00330-014-3494-1
  18. Sechtem U, Pflugfelder PW, Cassidy MM, White RD, Cheitlin MD, Schiller NB, et al. Mitral or aortic regurgitation: quantification of regurgitant volumes with cine MR imaging. Radiology 1988;167:425-430 https://doi.org/10.1148/radiology.167.2.3357951
  19. Alkadhi H, Leschka S, Trindade PT, Feuchtner G, Stolzmann P, Plass A, et al. Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery. AJR Am J Roentgenol 2010;195:900-908 https://doi.org/10.2214/AJR.09.3813
  20. Tanaka R, Yoshioka K, Niinuma H, Ohsawa S, Okabayashi H, Ehara S. Diagnostic value of cardiac CT in the evaluation of bicuspid aortic stenosis: comparison with echocardiography and operative findings. AJR Am J Roentgenol 2010;195:895-899 https://doi.org/10.2214/AJR.09.3164
  21. Dencker M, Stagmo M. Quadricuspid aortic valve not discovered by transthoracic echocardiography. Cardiovasc Ultrasound 2006;4:41 https://doi.org/10.1186/1476-7120-4-41
  22. Armen TA, Vandse R, Bickle K, Nathan N. Three-dimensional echocardiographic evaluation of an incidental quadricuspid aortic valve. Eur J Echocardiogr 2008;9:318-320
  23. Lee SC, Ko SM, Song MG, Shin JK, Chee HK, Hwang HK. Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings. Int J Cardiovasc Imaging 2012;28 Suppl 1:33-44
  24. Suh YJ, Kim YJ, Hong YJ, Lee HJ, Hur J, Im DJ, et al. Measurement of opening and closing angles of aortic valve prostheses in vivo using dual-source computed tomography: comparison with those of manufacturers' in 10 different types. Korean J Radiol 2015;16:1012-1023 https://doi.org/10.3348/kjr.2015.16.5.1012
  25. Hwang DM, Feindel CM, Butany JW. Quadricuspid semilunar valves: report of two cases. Can J Cardiol 2003;19:938-942
  26. Yildirim SV, Gumus˛ A, Coskun I, Turkoz R. Quadricuspid aortic valve: a rare cause of aortic regurgitation and stenosis. Turk J Pediatr 2008;50:500-502
  27. Sasahashi N, Ando F, Okamoto F, Hanada M, Kameyama T, Nishigaki Y. [A case of quadricuspid aortic valve associated with aortic steno-insufficiency]. Nihon Kyobu Geka Gakkai Zasshi 1997;45:1055-1060
  28. Sievers HH, Regensburger D, Bernhard A. Quadricuspid aortic valve with significant insufficiency. Thorac Cardiovasc Surg 1982;30:44-45 https://doi.org/10.1055/s-2007-1022206
  29. Attaran RR, Habibzadeh MR, Baweja G, Slepian MJ. Quadricuspid aortic valve with ascending aortic aneurysm: report of a case and discussion of embryological mechanisms. Cardiovasc Pathol 2009;18:49-52 https://doi.org/10.1016/j.carpath.2007.07.012
  30. Naito K, Ohteki H, Yunoki J, Hisajima K, Sato H, Narita Y. Aortic valve repair for quadricuspid aortic valve associated with aortic regurgitation and ascending aortic aneurysm. J Thorac Cardiovasc Surg 2004;128:759-760 https://doi.org/10.1016/j.jtcvs.2004.03.038
  31. Cho EJ, Son MK, Park SJ, Park SW, Chang SA, Lee SC, et al. Aggravating factors associated with the severity of aortic regurgitation and clinical characteristics of patients with quadricuspid aortic valve. J Heart Valve Dis 2015;24:148-155
  32. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2438-2488 https://doi.org/10.1016/j.jacc.2014.02.537

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