IV. Thoracic Aortography and Cineradiography of the Aortic Valve

Fifteen patients with aortic valve disease have been investigated at St. George's Hospital by thoracic aortography and cineradiography without complication. Their ages ranged from 8 to 56 years. The object in most cases was to assess the amount of aortic incompetence. With combined aortic stenosis and aortic incompetence, there may be doubt as to the degree of aortic incompetence even after clinical and routine radiological examination and study of the phonocardiograms and arterial pressure tracings. The pressure gradient across the aortic valve is particularly misleading. Similar gradients are encountered in severe aortic stenosis and in mild to moderate aortic stenosis with incompetence if there is a large forward strorke flow (Wood, 1958). This is because the gradient across a stenosed valve depends not only upon the cross section of a valve but also upon the blood flow through the valve. Unfortunately, it is not possible to measure the forward stroke flow in these cases of aortic stenosis with appreciable aortic incompetence. It was anticipated, therefore, that visual assessment of aortic reflux by cineradiography would help in assessing the relative haemodynamic importance of aortic stenosis and aortic incompetence.