CTICasesApicoaortic Conduit for Aortic Stenosis with Porcelain Aorta
Imaging findings
A patient with very severe aortic stenosis and a heavily calcified valve and porcelain ascending aorta has a conduit connecting the LV apex to the descending aorta, containing a small bioprosthetic valve. MRI shows the barely opening stenotic native valve with flow through the conduit valve. He did well for two years then returned with dyspnea; the conduit did not appear obstructed.
Key takeaways
An apicoaortic conduit is a valved graft from the LV apex to the descending aorta used to offload a very high transaortic gradient in patients with severe aortic stenosis who are poor surgical candidates (for example, porcelain aorta). Recognizing this uncommon device is important; historically used for congenital LVOT obstruction (later supplanted by the Ross procedure), it is now used only occasionally for inoperable aortic stenosis.
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