Computed Tomographic Evaluation of Congenital Left VentricularOutflow Obstruction

Figures

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  Fig. (1). Membrane-type subaortic stenosis. (A) Coronal contrast-enhanced computed tomographic angiography image and (B) thin volume rendered technique image showing a shelf-like fibromuscular in the subaortic region (arrow). (C) Axial minimum intensity projection image showing the classical appearance of the subaortic membrane (arrow). It falls short in the aortomitral region forming a horseshoe shape. Abbreviations: RA; right atrium, RV; right ventricle, LV; left ventricle, Ao; ascending aorta.

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  Fig. (2). Tunnel type subaortic stenosis (A) Coronal contrast-enhanced computed tomographic angiography image and (B) oblique coronal contrast-enhanced computed tomographic angiography image showing tunnel-like subaortic stenosis (arrows). Abbreviations: RA; right atrium, RV; right ventricle, LV; left ventricle, Ao; ascending aorta.

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  Fig. (3). Subaortic stenosis associated with ventricular septal defect. Sagittal oblique contrast-enhanced computed tomographic angiography image showing the ventricular septal defect. There is associated posterior deviation of the infundibular septum (asterisk) causing LV outflow tract obstruction. Abbreviations: LA; left atrium, LV; left ventricle, RV; right ventricle, Ao; ascending aorta, VSD; ventricular septal defect.

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  Fig. (4). Subaortic stenosis associated with hypertrophic obstructive cardiomyopathy. Oblique contrast-enhanced computed tomographic angiography three-chamber view image showing asymmetrical basal septal hypertrophy (arrow). Abbreviations: LA; left atrium, LV; left ventricle, Ao; ascending aorta.

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  Fig. (5). Schematic representation of various bicuspid aortic valve (BAV) morphologies according to the Sievers classification. The aortic valve is depicted on a cross-sectional short-axis view. The origin of the right coronary artery (RCA) and the left main (LM) are demarcated with red lines. Type 0: BAV without raphe, with lateral or anteroposterior orientation of the free edge of the cusps. Type 1: BAV with 1 raphe (in green), the most frequent type with the fusion of the right (R) and left (L) coronary cusps followed by fusion of the right and noncoronary (N) cusps. Type 2: BAV with 2 raphes.

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  Fig. (6). Type 0 (AP) bicuspid aortic valve. (A) Axial contrast-enhanced computed tomographic angiography image diastolic frame and (B) Axial contrast-enhanced computed tomographic angiography image systolic frame image showing a bi-commissural non raphe type 0 bicuspid aortic valve (arrows). The free cusps are oriented in the anteroposterior direction (AP subtype). Abbreviations: RA; right atrium, RVOT; right ventricular outflow tract, LA; left atrium, LV; left ventricle, Ao; ascending aorta.

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  Fig. (7). Type 1 (R-L) bicuspid aortic valve. (A) Axial contrast-enhanced computed tomographic angiography image diastolic frame and (B) Axial contrast-enhanced computed tomographic angiography image systolic frame image showing bicuspid aortic valve with a thick calcified raphe (arrow) between right and left coronary cusps (R-L subtype). Abbreviations: RA; right atrium, RVOT; right ventricular outflow tract, LA; left atrium, LV; left ventricle, Ao; ascending aorta, RCC; right coronary cusp, LCC; left coronary cusp, NCC; non-coronary cusp.

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  Fig. (8). Type 1 (R-N) bicuspid aortic valve. (A) Axial contrast-enhanced computed tomographic angiography image diastolic frame and (B) Axial contrast-enhanced computed tomographic angiography image systolic frame image showing bicuspid aortic valve with a thick calcified raphe between right and non-coronary cusps (R-N subtype). Abbreviations: RA; right atrium, RVOT; right ventricular outflow tract, LA; left atrium, LV; left ventricle, Ao; ascending aorta, RCC; right coronary cusp, LCC; left coronary cusp, NCC; non-coronary cusp.

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  Fig. (9). Type 2 bicuspid aortic valve. (A) Axial contrast-enhanced computed tomographic angiography image diastolic frame and (B) Axial contrast-enhanced computed tomographic angiography image systolic frame image showing bicuspid aortic valve with a two thin non-calcified raphe between right-left and right- non-coronary cusps. Abbreviations: RA; right atrium, RVOT; right ventricular outflow tract, LA; left atrium, LV; left ventricle, Ao; ascending aorta, RCC; right coronary cusp, LCC; left coronary cusp, NCC; non-coronary cusp.

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  Fig. (10). Axial contrast-enhanced computed tomographic angiography image showing the planimetry of the bicuspid aortic valve.

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  Fig. (11). Type 2 bicuspid aortopathy. (A) Axial and (B) coronal contrast-enhanced computed tomographic angiography image showing dilated ascending aorta. A small outpouching suggesting a pseudoaneurysm is seen arising from the right lateral aortic wall. (C) Frontal and (D) back cinematic rendered image showing dilated ascending aorta and pseudoaneurysm. Abbreviation: Ao; ascending aorta.

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  Fig. (12). Supravalvular aortic stenosis. (A) Axial contrast-enhanced computed tomographic angiography image showing the narrowed caliber of the supravalvular aorta (B) Coronal contrast-enhanced computed tomographic angiography image and (C) Volume rendered technique image showing supravalvular aortic stenosis (arrow). Abbreviations: RA; right atrium, LA; left atrium, LV; left ventricle, Ao; ascending aorta.