Bicuspid Aortic Valve and Coronary Artery Stenosis in the Cardiac CT

A 62-year-old Japanese man with a systolic heart murmur and dyspnea on effort visited our clinic in March 2011. He had not been previously treated for hypertension, diabetes mellitus or dyslipidemia. The cardiac-thoracic ratio was 65% on the chest X-ray. The resting electrocardiography showed the ST-segment depression in leads I, aVL and V 4 to V 6. The transthoracic echocardiography showed a moderate aortic valve stenosis (AS), with a suspected bicuspid aortic valve and 3.8 m/s in trans-aortic peak velocity, with a mild left ventricular hypertrophy. However, the details of the aortic valve morphology were unknown. We performed the 64-slice multidetector-row cardiac computed tomography (MDCT). We reconstructed the two kinds of the CT images to make the coronary artery image at the diastolic phase and the aortic valve image at the systolic phase during the whole cardiac cycles. The MDCT showed AS with a calcified and bicuspid aortic valve and 25-50% stenosis in the left anterior-descending coronary artery (LAD) (Figs. 1 and 2). The aortic valve area (AVA) estimated by utilizing the MDCT was 1.11 cm. The transesophageal echocardiography (TEE) and coronary angiography (CAG) were performed at the Kumamoto University Images in Cardiovascular Medicine