Morphology of congenital and acquired aortic valve disease by cardiovascular magnetic resonance imaging

• Cardiovascular magnetic resonance (CMR) is a rapidly evolving imaging modality which is becoming an important tool in the evaluation of valvular heart disease, especially aortic valve disease as it provides important information about the morphology of the aortic valve which is essential in the management of patients with congenital and acquired aortic valve lesions. This review the optimal use of CMR in the assessment of aortic valve disease and also illustrates the typical and distinguishing morphological features seen on CMR in a range of congenital and some common acquired aortic valve lesions which are encountered in daily clinical practise. It will be helpful for clinicians (both imaging cardiologists and radiologists) to recognise the typical and distinguishing morphological appearances of these aortic valve lesions. Although echocardiography remains the major imaging modality for assessment of aortic valve disease, CMR provides “added value” to existing assessment and can complement the echo assessment.

Echocardiography is the principal non-invasive tool for initial evaluation and longitudinal monitoring of patients with significant valvular heart disease. However echocardiography can be limited by poor acoustic windows, and is dependent on the skill and experience of the sonographer. Cardiovascular magnetic resonance (CMR) can provide a comprehensive non-invasive assessment of valvular morphology, quantification of the severity of valvular dysfunction, determination of its aetiology, assessment of the consequences for the heart from the valve lesion including measurement of ventricular volumes and function, and evaluation of haemodynamic abnormalities. Additional information such as great vessel anatomy and the presence of coronary disease and myocardial scar can also be obtained from CMR. Aortic valve disease can manifest as aortic regurgitation, aortic stenosis or a mixture of both. Structural abnormalities of the valve (congenital or acquired) or disease of the aorta (structurally normal valve) can cause aortic valve disease. This review describes the role of CMR in evaluation of patients with aortic valve diseases, and illustrates the typical and distinguishing morphological features seen on CMR in a range of congenital and some common acquired aortic valve lesions. Although CMR can provide important information about the morphology of aortic valve, its full potential has yet to be realised, and further studies of clinical outcomes are needed before CMR data can be integrated into the management of patients with significant aortic valvular lesions.