PMC5816879_01
(a) MSCT of the right illiofemoral artery demonstrating an MLD of 5.8 mm. (b) MSCT of the left illiofemoral artery demonstrating heavy calcification just at the level of the femoral head and an MLD of 5.7 mm. (c) MSCT of the descending aorta. The white line denotes the maximum diameter of 46 mm. (d) MSCT of the ascending aorta. The black line denotes the maximum diameter of the ascending aorta aneurysm measuring 60 mm. The black arrow shows the left subclavian entering the right brachiocephalic trunk (the bovine arch).
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Multislice computed tomography (MSCT) showed a heavily calcified, tortuous iliofemoral vasculature (minimal lumen diameter (MLD) right: 5.7 mm; left: 5.8 mm), small subclavian arteries (MLD: 4.5 mm), and a bovine aortic arch (Figure 1).
(a) MSCT of the aortic annulus with the diameter of 26.4 mm, perimeter of 84.4 mm, and aortic annular area of 542 mm2. (b) MSCT of the aortic valve demonstrating a tricuspid aortic valve with heavy calcification of the aortic valve leaflets.
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The trileaflet aortic valve was heavily calcified (annular dimensions: mean diameter 26.4 mm; area 542 mm2; perimeter 84.4 mm) (Figure 2).
(a) Control angiography showing complete occlusion of the left femoral artery just distal to the puncture site. (b) MSCT of the left femoral artery showing heavy calcification at the level of the femoral head. Red arrow shows puncture site. (c) Calcific atheroma from the left common femoral artery during the femoral endarterectomy.
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Control femoral angiography, however, showed occlusion of the common femoral artery just caudal to the puncture site (Figure 3(a); Video 4), and an area of extensive calcific plaque was observed on the screening MSCT (Figure 3(b)). In light of the extensive calcific disease, it was deemed that percutaneous recanalization of the artery would be impossible, and a common femoral endarterectomy was performed (Figure 3(c)).
(a) MSCT of the 31 mm CoreValve in the aorta postimplant. (b) Aortic end of the CoreValve "floating" in the aorta. (c) 3D reconstruction of the CoreValve showing apposition to the greater curvature of the aorta.
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Repeat MSCT showed a well-positioned valve, with the outflow floating in the ascending aortic aneurysm, without evidence of in situ thrombus, and no expansion of the ascending or descending aortic aneurysms (Figure 4).