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Everything you need to know about Computed Tomography (CT) & CT Scanning

4D Imaging of the Aortic Valve: Real Time Videos

4D heart

3D and 4D rendering of the heart with emphasis on the aortic valve. Example of the valve opening and closing, shown dynamically by 4D CT.


Bicuspid Aortic Valve 

4D of a patient with a bicuspid aortic valve. Please note that the best way to visualize the bicuspid valve in this case is the Fishmouth configuration, when the valve is open.

Bicuspid valve

4 dimensional and 3 dimensional visualization of the aortic valve prior to operative repair. This is a bicuspid valve.


Calcified aortic valve

3D and 4D mapping demonstrates a tricuspid aortic valve with calcifications on the valve.



A series of 3 dimensional and 4 dimensional views are provided defining a patient with prior repair of a coartation. The 4 dimensional imaging of the heart, with a special focus of the aortic valve shows that it functions normally.

Mechanical aortic valve

Coronary artery disease with prosthetic valve which functions normally.

Aortic valve

The study is an excellent example of dense calcification of the aortic valve leaflets leading to aortic stenosis and poststenotic dilatation. Calcifications with this appearance are typically seen in patients with bicuspid aortic valves.


This study is a gated acquisition of a patient with a type A dissection. Note that on the 4D images the importance of the cardiac motion, as well as visualization of the flap is clearly defined. Gating may become the standard for evaluation of the ascending aorta because it allows us to not only see the ascending aorta, which one can visualize fairly well on axial imaging, but also define extent dissection as it relates to coronary arteries

4D heart

Sequence of images showing 3D and 4D evaluation of the Aorta and aortic root including aortic valve motion with clear definition of aortic valve opening and closing. Note the value of reversing the look up tables which give a better definition of the cardiac valves.

Dilated aortic root

A sequence of images defines the dilated aortic root with good definition of both the root and valve. The use of 3D and 4 D imaging is nicely shown in this case. Note calcification in the patient's left anterior descending coronary artery.

Arch Pseudoaneurysm

A sequence of images is provided using both 3D and 4 D reconstruction in a complicated case of a patient with a pseudo-aneurysm off the aortic arch. 3D mapping defines the extent of aneurysm using a series of axial, coronal, and sagittal planes with volume rendering and 3D mapping. The 4 dimensional reconstructions also nicely show the ulceration with aneurysm off the arch. This can be best described as a pseudo-aneurysm. The multiple volume rendered views nicely show the pseudo-aneurysm.

Prior cardiac surgery

The patent has a history of prior cardiac surgery. Notice the bulge off the right side of the ascending aorta consistent with a pseudo-aneurysm, possibly iatrogenic in nature. This is clearly seen on all 3D reconstructions as a discreet out-patching. This would be eventually repaired by banding.

Repaired coarctation of the aorta

This is a nice example of a patient who had a coarctation of the aorta, which was subsequently repaired. It was literally impossible to try to figure out the anastomoses when one looked only at the axial images, but in 3D, this is very clear exactly where the anastomoses are. This is just a great example of where multiplanar and 3D imaging becomes so critical.

Focal pseudo aneurysm of the ascending aorta

Multiple sequences using 3D imaging defining the focal pseudo aneurysm of the ascending aorta. This is also nicely seen on some of the 4D images.

Right Arch with Mirror Branching

This is an example of an unusual variation of a right-sided arch with a near double aortic arch but lack of connection of the left portion and right portion of the arch. There is mirror branching present as well. This configuration can lead to airway compression but not with the frequency that one would see with a true double aortic arch. The patient does have a diverticulum off the left component of the arch.


© 1999-2020 Elliot K. Fishman, MD, FACR. All rights reserved.