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J.Jpn. Surg. Soc.. 122(5): 484-492, 2021


Feature topic

PROGRESS IN DIAGNOSTIC TECHNOLOGY FOR AORTIC VALVE DISEASE

1) Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
2) University of Occupational and Environmental Health, Kitakyushu, Japan

Naoto Murakami1), Akihiro Isotani1), Yutaka Otsuji2), Shinichi Shirai1)

Aortic valvular stenosis (AS) is now a pandemic. Echocardiography allows quantitative diagnosis of AS. Indications for aortic valve replacement or transcatheter aortic valve implantation (TAVI) are evaluated based on a combination of clinical signs/symptoms and echocardiographic findings according to the treatment guidelines. In patients for whom TAVI is planned, contrast-enhanced 3D computed tomography (CT) is essential. It allows 3D evaluation of aortic valve anatomy/calcification, aortic root complex, coronary anatomy, and left ventricular outflow structure. 3D CT imaging allows preoperative planning of TAVI as well as intraoperative navigation by superimposing preoperative CT images and intraoperative fluoroscopic images. Postoperative CT is useful to diagnose thrombotic aortic valve. The number of patients with paradoxical low-flow, low pressure-gradient AS is rapidly increasing. These patients’ stenotic aortic valves may represent a “pseudo-severe” physiological type, which requires wide application of exercise-stress echocardiography.


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