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Computed tomographic imaging of patients with native and prosthetic aortic valve stenosis
  1. Jolien Geers1,
  2. Rong Bing2
  1. 1 Department of Cardiology, CHVZ (Centrum voor Hart- en Vaatziekten), Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
  2. 2 Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Jolien Geers, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussel 1090, Belgium; jolien.geers{at}

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Learning objectives

  • To understand the role of cardiac CT aortic valve calcium (CT-AVC) in defining stenosis severity in patients with aortic stenosis and discordant echocardiographic measures.

  • To understand the limitations of CT-AVC scoring and how these limitations can potentially be addressed with contrast-enhanced CT.

  • To understand the key features that need to be assessed on a CT scan in patients being evaluated for transcatheter aortic valve (AV) intervention.

  • To understand the adjunctive role of cardiac CT in patients with clinical prosthetic AV disease such as leaflet thrombosis or structural valve degeneration.


The healthcare burden posed by aortic stenosis (AS) requires no elaboration. Although it is a familiar disease entity that is delineated by a relatively straightforward clinical paradigm, there are still unresolved questions that can make optimal diagnosis, management and follow-up challenging in some patients. In recent years, computed tomography (CT) has become an indispensable tool in cardiology in view of its excellent spatial resolution, low doses of ionising radiation and widespread availability. Its application in AS is no exception. Cardiac CT may aid in the assessment of native aortic valve (AV) disease, facilitate preprocedural planning for valve interventions and improve the assessment of prosthetic valve dysfunction and structural valve degeneration. This Education in Heart piece will take you through the above, considering at each stage the advantages and disadvantages of CT and the relevant evidence base.

AS evaluation—do we really need another test?

Echocardiography is the principal imaging modality for the assessessment of AS. When image quality is good, and the full hand of echocardiographic haemodynamic parameters is met1 and accompanied by typical symptoms and signs of severe AS, the diagnosis is straightforward. However, often the picture can be clouded by uncertainty regarding echocardiographic parameters of stenosis severity, image quality and confounding low-flow states. In these circumstances, CT can add value.

Echocardiographic measurements are the current first-line …

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  • Contributors JG drafted the first version. JG and RB edited and approved the final manuscript.

  • Funding This work was supported by the European Association of Cardiovascular Imaging (Research Grant 2022).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.