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.