2007
DOI: 10.1055/s-2006-924712 View full text |Buy / Rent full text
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Abstract: We report a case of a 65-year-old man with obstruction in an aortic St. Jude Medical (SJM) valve caused by pannus. Serial cineradiography demonstrated a gradual increase in the restriction of the leaflet opening without echocardiographic abnormalities for 4 years before echocardiography finally showed obstruction of the aortic SJM valve. The cause of obstruction could not be determined even by transesophageal echocardiography; however, multidetector-row computed tomography clearly defined pannus in the ventric… Show more

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“…Although Barbetseas et al indicated that a videointensity ratio of <0.7 on TEE had the best negative predictive value for thrombi on the prosthetic valves, 19 subprosthetic overgrown pannus was not found even on TEE in our experience, because a small amount of pannus or thrombus at the pivot systems generally leads to restricted leaflet motion rather than complete block in the SJM valves. 4,6,12, 14 In contrast, cineradiography gives information on leaflet motion in prosthetic valves, but it is not always possible to obtain a tangential view of an implanted bileaflet valve. 11, 20 These facts indicate that a combination of echocardiography with cineradiography is the most appropriate for accurate and early diagnosis of PVO.…”
Section: Discussionmentioning
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“…Although Barbetseas et al indicated that a videointensity ratio of <0.7 on TEE had the best negative predictive value for thrombi on the prosthetic valves, 19 subprosthetic overgrown pannus was not found even on TEE in our experience, because a small amount of pannus or thrombus at the pivot systems generally leads to restricted leaflet motion rather than complete block in the SJM valves. 4,6,12, 14 In contrast, cineradiography gives information on leaflet motion in prosthetic valves, but it is not always possible to obtain a tangential view of an implanted bileaflet valve. 11, 20 These facts indicate that a combination of echocardiography with cineradiography is the most appropriate for accurate and early diagnosis of PVO.…”
Section: Discussionmentioning
“…11, 20 These facts indicate that a combination of echocardiography with cineradiography is the most appropriate for accurate and early diagnosis of PVO. 4, 14 An important disadvantage of these techniques, however, is difficulty in visualizing and identifying underlying causes of PVO even by a combination of these 2 techniques. From a surgical standpoint, identification of the exact cause of PVO is essential for deciding the appropriate therapeutic strategy (ie, thrombolysis or surgical treatment).…”
Section: Discussionmentioning
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“…CT images can also help visualize the morphology and motion of native and diseased stenotic aortic valves and precisely measure aortic valve opening areas. Several studies [39][40][41][42][43][44][45] suggest that multidetector CT can help assess mechanism of dysfunction in mechanical prosthetic heart valve disorders.…”
Section: Discussionmentioning
“…The use of multidetector-row computed tomography is a useful technique used to evaluate dysfunctional prosthetic valves. When combined with cineradiography, both can demonstrate any abnormal small tissue extending from the left ventricular septum into the prosthetic aortic valve [10]. In technically inadequate or borderline cases, transoesophaged echocardiography (TEE) and more recently, the use of three-dimensional (3D) TEE was shown to be effective in diagnosis and visualization of leaflet immobility [1,11].…”
Section: Commentarymentioning