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With this next video,

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we're gonna review how to perform aortic valve calcium scoring.

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So I've opened up a case, a calcium scoring software that I have.

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This is from one particular vendor,

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but all the vendors have more or less similar approach. Um,

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with this particular piece of software,

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all of the calcium pixels are labeled with pink.

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And the pink shows you any pickles that are above 130 pounds foot unit,

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which is the standard threshold for ton scoring.

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And what you're gonna do is you're gonna go down to the level of the aortic

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valve and identify the calcium and then click on it so that it's segmented

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by the software. So here's a big hunk of aortic valve calcium there, uh,

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there's another hunk over there and then it looks like there's

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some over here as well, probably here as well.

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That's probably it.

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Now one of the things you're gonna run into is it's really hard sometimes to

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figure out on the axial slice whether or not the calcification

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belongs to the aortic valve itself or belongs to the region below the aortic

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valve. The annulus or the L V O T.

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One approach you can use is to look at the contrast

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enhanced images at the same time,

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and that'll help you with your orientation in your anatomy.

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So if you pull up a separately, a set of contrast,

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enhanced images and look through the axial plane,

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then you can use that to figure it out.

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The other thing you can do if you have that ability, depending on your software,

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is you can actually create oblique images through the aortic valve.

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So for this particular piece of software, I can see that's the left coronary,

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that's the valve. And if I make an oblique image,

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then I can actually see where my selections are relative to

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what I think is the aortic valve plane, which is right about here.

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And so it looks like,

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actually I've got some calcifications right here below the aortic valve.

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And when you scroll through on the axial images,

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I think those are pretty easy to see.

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The aortic valve calcifications usually take kind of a semi-circular shape, um,

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and follow the edges of the valve leaflets. And you can see there's one leaflet,

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the non coronary cusp, there's the, uh, left coronary cusp,

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and here's the right coronary cusp.

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And this little blob of calcium here seems to actually be below

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the commissure between the non coronary and the right cusps.

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So in order to remove that blob, I need to actually,

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for the software go back to the axial position and then find that

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extra bit of calcification there.

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And then if I erase it on a slice by slice basis,

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just by circling the area of interest, I should be in good shape.

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Now I have to circle it because if I do it, just click,

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then it'll segment out the entire area and I'll lose that entire left cusp,

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which I don't want. Okay, so now I think I'm in good shape. It looks to

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Me,

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me like I've captured all the calcium and I've got a calcium score down here,

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which is 2,456.

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And we know from the previous discussion the aortic valve calcification

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video that for men,

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the threshold for known severe AOR stenosis is 3000.

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So this is a, a male patient, he is actually below that threshold,

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so we wouldn't be able to automatically place him in the severe AIC stenosis

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category. We would have to look at other measurements. Um, in particular,

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you know,

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the echo measurements of aortic valve area velocity across the aortic valve and

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the aortic valve gradient.

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So this is just a summary of approach to doing aortic valve calcium score, uh,

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in patients with tavr.