Preliminary Diagnosis: Aortic Sclerosis
I. What imaging technique is first-line for this diagnosis
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Gray scale and color doppler echocardiography (transesophageal offers better resolution compared to transthoracic)
II. Describe the advantages and disadvantages of this technique for diagnosis of Aortic Stenosis.
Advantages
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Highly portable, fast, and relatively inexpensive imaging modality.
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Does not expose patients to ionizing radiation.
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Disadvantages
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Highly operator dependent.
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Offers exquisite visualization of turbulent flow across the valve and details high pressure gradients seen in patients with aortic stenosis/sclerosis.
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Cannot be used for intervention.
III. What are the contraindications for the first-line imaging technique?
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No specific contraindications to echocardiography exist.
IV. What alternative imaging techniques are available?
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Cardiac CTA
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Cardiac MR
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Conventional Cardiac Angiography.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Aortic Sclerosis.
Cardiac CTA
Advantages
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Offers more exquisite detail of the surrounding soft tissues, osseous structures, and soft tissues.
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More sensitive and specific in evaluating for calcification and thickening of the leaflets than echocardiography
Disadvantages
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Does not offer dynamic imaging capability.
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Exposes patients to ionizing radiation.
Cardiac MR
Advantages
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Does not expose patients to ionizing radiation.
Disadvantages
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Must be cardiac gated and may be subject to motion artifact and flow artifact from inadequate gaiting.
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May not be performed in patients with non MR compatible hardware.
Conventional Cardiac Angiography
Advantages
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Useful in diagnosis and treatment in patients with aortic stenosis.
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Offers exquisite dynamic imaging capabililty and delivers highly specific information on valvular flow.
Disadvantages
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Less exquisite in detailing the anatomy of the surrounding soft tissues, vascular structures, and osseous structures,
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Exposes patients to large amounts of ionizing radiation.
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Highly invasive and is associated with more morbidity and mortality compared to companion non invasive imaging techniques.
VI. What are the contraindications for the alternative imaging techniques?
Cardiac CTA
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May not be performed in pregnant patients.
Cardiac MR
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Contraindicated in patients with non MR compatible hardware.
Conventional Cardiac Angiography
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Contraindicated in patients who are in a severe hypocoaguable state.
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Non iodine based contrast agents such as CO2 may have to be used in patients with a contrast allergy.
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