A 79-year-old woman with known severe aortic stenosis and concomitant moderate aortic regurgitation underwent electrocardiogram-gated cardiac computed tomography angiography in addition to TEE for planning of trancatheter aortic valve implantation, which was preferred to conventional valve replacement with sternotomy due to severe comorbidities (EuroScore 29.7%). The examination was performed on a dual source CT scanner (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany) with retrospective ECG-gating.
Double-oblique transverse multiplanar reconstruction during mid-diastole (70% of RR-interval) and during end-systole (300 ms past the R-peak) as well as TEE images are shown. A quadricuspid valve with four separate leaflets is seen. Leaflet margins were found to be thickened with mild to moderate calcifications. Diastolic reconstructions revealed a central zone of incomplete coaptation. By means of planimetry, this regurgitant orifice measured 0.12 cm, consistent with moderate aortic regurgitation seen on transesophageal echo (vena contracta 3 to 4mm). On systolic reconstructions, incomplete opening was observed (aortic valve area 0.8cm2
), consistent with severe aortic stenosis.