Aortic valve chordae tendineae: A rare cause of aortic stenosis

Abstract

We describe a rare case of severe low-flow, low-gradient aortic stenosis due to a calcified aortic valve chordae tendineae. The chordae was captured on cardiac computed tomography (CT) using advanced 3-dimensional image reconstruction to reveal the fibrous strand tethering the non-coronary cusp to the left ventricular outflow tract, rendering it functionally immobile. This is one of the first reported cases of severe aortic stenosis from an aortic valve chordae tendineae which highlights the utility of advanced image processing techniques in cardiac CT.

Keywords: Aortic stenosis; Aortic valve; CABG, coronary artery bypass graft; Chordae tendineae; Fibrous strand; LVEF, left ventricular ejection fraction; LVOT, left ventricular outflow tract; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram.

Fig. 1

Cardiac CT of aortic valve chordae tendineae. Multi-planar reformatted image (A) and volumetric 3D display (B) of the LVOT and aortic root with a notably calcified aortic valve and fibrous strand (arrow) tethering the non-coronary cusp to left ventricular outflow tract. A right coronary cusp cut-away of a 3D STL display (C) shows a longitudinal view of chordae (teal) with aortic calcifications (yellow). A subvalvular projection of the aortic valve (D) visualizes the fibrous strand attachments to the non-coronary cusp and LVOT.

Fig. 2

Mid esophageal TEE of aortic valve: Tricuspid heavily calcified aortic valve visualized in early systole (A) and diastole (B) on mid esophageal short axis view.