Aortic Dissection

1.Annulus2. Bisinal diameterNormal aortic root3. Sino‐tubular junction4. Ascending aortaNormal Size of aortic root

Aortic valve anatomy

Aortic Root aneurysmDiagnose site, localized or diffuseNumber (single or multiple)shape (succular , fusiform )involvement of great vessels, coronary arteriesInvolvement of aortic valve , sinotubular junctioncomplicationsAneurysm of the aorta is defined as dilation ofthe aorta involving all three wall layersequaling or exceeding twice the normaldiameter.Pseudoaneurysms (false aneurysms) representsaccular dilations that do not contain aorticintima

Aortic aneurysm62Y old female had Bicuspid aortic valve and severe AIreferred for coronary angiography before surgery Failed

62Y old female had Bicuspid aortic valve and severe AIreferred for coronary angiography before surgery Failed62Y old female had Bicuspid aortic valve and severe AIreferred for coronary angiography before surgery Failed

Aortic DissectionThe goals of MDCT imaging are to:1. identify the intimal flap and entry site2. identify any branch vessel involvement3. identify the presence of pericardial fluid(intrapericardial rupture) or periaortic hematoma4. identify extent of dissection5. evaluate size of the aorta6. evaluate the patency of the false lumen and degree oftrue lumen compression

Aortic Dissection

Aortic DissectionAortic DissectionStanford type A

Aortic DissectionAortic Dissection

Aortic DissectionAortic Dissection

Aortic DissectionAortic valvenot an indication of MDCT but obtained during CT aortography* Number of cusps* annular diameter* Calcification* Vegetations* Valvular, Supra valvular or subvalvularstenosis (AVA by planimetry)

Aortic valveBicuspid aortic valve

Degenerative aortic stenosisSupravalvular aortic stenosis

Supravalvular aortic stenosis20Y male, Dyslipidemia, chest pain

Prosthetic aortic valve

Prosthetic aortic valveCoronary arteries

Marfan’s Syndrome‐Aortic root dilatation‐Sinotubular junctioneffacement‐Loss of leaflet cooptation‐Dilated LV

Annuloaortic ectasia without valvular insufficiency in a 20-year-old man.Sinus of Valsalva aneurysm

Sinus of valsalva aneurysmRuptured sinus of valsalva

Aortic root abscess* diagnose site, size,* Opening into the aortic root* Relation to aortic valve and coronary arteries* Relation to surrounding structures* Complications 9leak , rupture, effusion….52 Y old M, presented with IE onBicuspid aortic valve

52 Y old M, presented with IE onBicuspid aortic valve

52 Y old M, presented with IE onBicuspid aortic valve42y old female 2 months after open Mitralcommissurotomy

42y old female 2 months after openMitral commissurotomy

Diagnosis of rare congenital abnormalities30 Y old F with Turner’s S. Bicuspid aortic valve and turbulencein LVOT and aortic root by Echocardiography30 Y old F with Turner’s S. Bicuspid aortic valve and turbulencein LVOT and aortic root by Echocardiography

Virtual endoscopic views* can enable a more accurate presurgicalevaluation of the aortic valve* Aortic wall composition, and calcification* Prosthetic valve mobility* Diagnose coronary ostia esp. with ostial lesionor calcificationVirtual endoscopic views

Virtual endoscopic viewsCalcific aortic valveVirtual endoscopic viewsaortic root dissection flap

Virtual endoscopic viewsprosthetic aortic valve

Virtual endoscopic viewsAortic valve vegetationFly Through Technique

Take Home MessageMDCT is an accurate , rapid and non‐invasiveidiagnostic modality for diseases of the aortic root.Multi‐modality imaging helps to delineate bothanatomical and functional abnormalities in aorticroot diseases.MDCT is Mandatory for Pre‐operative evaluationbefore acute aortic syndromes, aortic rootabscess, undiagnosed fistulas tracts, or suspectedcomplicationsThank YouDr. Eman El Sharkawy