How is aortic valve disease diagnosed?

The diagnosis of aortic valve disease is generally done both based on clinical examination of the patient as well as with the aid of certain investigations. Any patient who presents with shortness of breath would have a clinical examination and in the presence of severe aortic valve disease the expert would be able to pick up a murmur by using a stethoscope placed on the chest of the patient. Presence of a murmur would suggest significant valvular disease, and that generally would then result in a battery of investigations. The most important investigation to diagnose the aortic valve disease is an echocardiogram or an echo scan of the heart. The echo scan would pick up abnormalities which then would be analyzed and give us an idea about the severity of the aortic valve disease. Patients who have severe aortic valve disease would generally require either surgical or transcatheter treatment once they've been diagnosed. And they would then require further investigations to assess their fitness for surgery and whether or not they are candidates for an open operation or they would be considered for transcatheter aortic valve implantation. If someone is having transcatheter aortic valve implantation then they would generally undergo what we call as a TAVI CT scan. A TAVI CT scan is a special scan where you are essentially scanned from head to toe And the focus is mainly on the big blood vessel in the body called the aorta. And the reason for it is that you want to make sure that if you are going to use one of the branches of the aorta, either the femoral artery in the groin or the subclavian artery under the collarbone or the carotid artery in the neck, then the scan would give you information about whether these arteries are usable or not. criteria that we would normally use are the size of the vessel, also whether these vessels are furred up or not, which means that whether they have any calcific plaques in them, and also whether these arteries are relatively straight or there's lots of angulation and kinks in them, which can make the procedure technically challenging. So all of this information is obtained with the help of a TAVI scan. A TAVI scan also gives us information about the size of the aortic valve, the degree of calcification or firing up of the aortic valve. It also gives us information about the relationship of the aortic valve to the coronary arteries, which are basically the arteries that provide blood to the heart muscle. Sometimes if these coronary arteries are very low and close to the aortic valve, then that makes a TABI almost impossible to perform because there is a risk that if you implant a TABI valve in patient who has low coronary arteries, then they can block off the coronary arteries. So all this information is vital for us to plan the procedure. And without a TAVI CT scan, no one is gonna be confident to perform the procedure. Hence TAVI CT scan is an important part of the investigation process for us to decide whether a patient can be offered TAVI or not.