Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT.
Aortic valve bypass is a technique used in high-risk patients with critical aortic stenosis that consists of placement of a conduit from the left ventricular apex to descending aorta. We describe the imaging appearances of this apicoaortic conduit on multidetector CT (MDCT). Each patient underwent retrospective ECG-gated MDCT using a 16-detector-row scanner several days after placement of an apicoaortic conduit. All images were assessed by two radiologists who reviewed the appearance of the apicoaortic conduit and any post-operative complications. Follow-up studies were available for several patients. Twelve patients (9 men, 3 women, mean age - 78 years) underwent evaluation and the conduit was visible in each. The valve within the conduit was visible in ten (91%) of the 11 patients who received intravenous contrast material. Common findings were periconduit outpouching and hypoperfusion involving the left ventricle. Complications included pericardial hemorrhage, hemothorax and ventricular pseudoaneurysm. Mild to moderate increase in wall thinning was identified in the three patients who underwent follow-up imaging. Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.