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Number 08-06 Coarctation & aortic stenosis

Case from: Gulati GS, Naik N, Sheorain V, Sharma S. Cardiothoracic Center All India Institute of Medical Sciences, Ansari Nagar, New Delhi

History: A 46 year old male with 6 months breathlessness. Previous patch repair of “adult type” CoA.

12 lead ECG: LVH

Echocardiogram: Bicuspid, calcified Ao valve, gradient 85mmHg.

CMR referral: Evaluate status of CoA repair.

CMR Cine: LVH, bicuspid Ao valve with turbulent flow. No significant AR. AVA=1.1 cm2 by planimetry. [top]

CMR Black Blood and Angiography: Residual membrane without re-coarctation and a 3.4 cm fusiform aneurysm at the repair site. [middle]

LGE: Apical subendocardial and diffuse mid-zone LGE seen at multiple sites consistent with myocardial fibrosis. [lower]
Interpretation: Bicuspid Ao valve with moderate stenosis, fusiform aneurysm of the repair site, focal and subendocardial LGE.

CMR Points: The flexibility of CMR allows both the evaluation of the anatomy of the CoA, the pathophysiology of the bicuspid aortic valve, and raises questions about myocardial disease in these conditions.

Reference: CMR in congenital heart disease. (full text)

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