Aortic Sclerosis

Preliminary Diagnosis: Aortic Sclerosis

I. What imaging technique is first-line for this diagnosis

• Gray scale and color doppler echocardiography (transesophageal offers better resolution compared to transthoracic)

II. Describe the advantages and disadvantages of this technique for diagnosis of Aortic Stenosis.

Advantages

• Highly portable, fast, and relatively inexpensive imaging modality.

• Does not expose patients to ionizing radiation.

Disadvantages

• Highly operator dependent.

• Offers exquisite visualization of turbulent flow across the valve and details high pressure gradients seen in patients with aortic stenosis/sclerosis.

• Cannot be used for intervention.

III. What are the contraindications for the first-line imaging technique?

• No specific contraindications to echocardiography exist.

IV. What alternative imaging techniques are available?

• Cardiac CTA

• Cardiac MR

• Conventional Cardiac Angiography.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Aortic Sclerosis.

Cardiac CTA

Advantages

• Offers more exquisite detail of the surrounding soft tissues, osseous structures, and soft tissues.

• More sensitive and specific in evaluating for calcification and thickening of the leaflets than echocardiography

Disadvantages

• Does not offer dynamic imaging capability.

• Exposes patients to ionizing radiation.

Cardiac MR

Advantages

• Does not expose patients to ionizing radiation.

Disadvantages

• Must be cardiac gated and may be subject to motion artifact and flow artifact from inadequate gaiting.

• May not be performed in patients with non MR compatible hardware.

Conventional Cardiac Angiography

Advantages

• Useful in diagnosis and treatment in patients with aortic stenosis.

• Offers exquisite dynamic imaging capabililty and delivers highly specific information on valvular flow.

Disadvantages

• Less exquisite in detailing the anatomy of the surrounding soft tissues, vascular structures, and osseous structures,

• Exposes patients to large amounts of ionizing radiation.

• Highly invasive and is associated with more morbidity and mortality compared to companion non invasive imaging techniques.

VI. What are the contraindications for the alternative imaging techniques?

Cardiac CTA

• May not be performed in pregnant patients.

Cardiac MR

• Contraindicated in patients with non MR compatible hardware.

Conventional Cardiac Angiography

• Contraindicated in patients who are in a severe hypocoaguable state.

• Non iodine based contrast agents such as CO2 may have to be used in patients with a contrast allergy.