This is a systolic still-frame of an aortic root angiogram in the anteroposterior view from our patient. The tip of the pigtail catheter is in the ascending aorta where contrast material has been injected.
The arrows identify the narrow stream or jet of unopacified blood entering the dilated ascending aorta from the left ventricle through the stenosed aortic valve orifice. The right and left coronary arteries are also opacified.
In the real-time study that follows, note the restricted motion of the stenosed bicuspid aortic valve leaflets and their domed appearance in systole. Note also the small amount of contrast material entering the left ventricle during diastole, due to trivial aortic valvular regurgitation.
Ao root angio - lat view
This is a systolic still-frame of an aortic root angiogram in the lateral view from our patient. The tip of the pigtail catheter is in the ascending aorta where contrast material has been injected.
The aortic valve is bicuspid, with fused right and left leaflets and a large posterior leaflet.
The small, oval-shaped, unopacified area between the cusps is due to a stream of blood exiting the left ventricle and outlines the small aortic valve orifice.
In the real-time study that follows, note the motion of the stenotic bicuspid aortic valve. Note also the trivial amount of aortic regurgitation.
AS cath data
These are the simultaneous left ventricular and aortic root pressure tracings of our patient. The delayed onset of the aortic pressure curve is due to a difference in the two catheter systems.
The tracings clearly show an elevated left ventricular pressure and a significant systolic gradient across the aortic valve of 85 mm of Hg.
The calculated valve orifice size is 0.5 cm2, reflecting severe aortic stenosis. The cardiac index is normal.