Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction

Gündüz, Sabahattin; Özkan, Mehmet; Kalçık, Macit; Gürsoy, Ozan Mustafa; Astarcıoğlu, Mehmet Ali; Karakoyun, Süleyman; Aykan, Ahmet Çağrı; Biteker, Murat; Gökdeniz, Tayyar; Kaya, Hasan; Yesi̇n, Mahmut; Duran, Nilüfer Ekşi; Sevinc, Deniz; Güneysu, Tahsin

doi:10.1161/circimaging.115.003246

Cited by 101 publications

(57 citation statements)

References 34 publications

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“…Post-TAVI leaflet thrombosis is detected by high-resolution CT in the form of limited valve opening/closure3 and hypoattenuated leaflet thickening (HALT) (figure 1). 3 4 Although no direct evidence is available, it seems certain that these signs truly indicate the adhesion of a thrombus for two reasons: both signs are ameliorated by anticoagulant therapy5 and CT delineates thrombi as low attenuation while pannus as high attenuation 6. Echocardiography too is capable of detecting limitations of valve opening/closure, leaflet thickening, increased flow velocity across the valve and increased mean pressure differences, and shows such changes 2 7 8.…”

Section: Imaging Features Of Post-tavi Leaflet Thrombosismentioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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Although clinically significant valve thrombosis after transcatheter aortic valve implantation (TAVI) is rare, the incidence of subclinical leaflet thrombosis has been reported to be up to about 10%-15%. It is mostly found 1-3 months after procedure in any type of transcatheter heart valve. Leaflet thrombosis is detected by high-resolution CT in the form of limited valve opening/closure and hypoattenuated leaflet thickening. Transthoracic or transesophageal echocardiography is capable of detecting limitations of valve motion, leaflet thickening, increased flow velocity across the valve. However, CT seems to be more sensitive than echocardiography to detect leaflet thrombosis. It can occur under dual antiplatelet therapy with aspirin and a thienopyridine but rarely occurs with anticoagulation with a vitamin K antagonist. A vitamin K antagonist is also helpful to resolve leaflet thrombosis. Several studies are ongoing to determine the effect of new oral anticoagulants (NOACs) in preventing major cardiovascular events. They will also provide useful information on whether NOACs prevent leaflet thrombosis.

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Section: Imaging Features Of Post-tavi Leaflet Thrombosismentioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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“…Both systolic (at 20% to 40% of RR interval) and diastolic phase (at 70% to 90% RR interval) are usually necessary. With these modalities, more than 90% of the valves can be accurately evaluated (6). As opposed to retrospective triggering, prospective ECG-gated protocols tend to generate less artifacts and require lesser radiation doses.…”

Section: Ct Scan Techniquementioning

confidence: 99%

Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves

Aladmawi¹,

Pragliola²,

Vriz³

et al. 2017

J. Thorac. Dis.

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Aortic valve replacement (AVR) is the second most common cardiothoracic procedure performed in the United States (1) and Europe (2). Surgically or percutaneously implanted, the results of AVRs are uniformly good and the number of patients have been steadily increasing over the last decades (3). Although most of the newly implanted devices are tissue valves, yet a sizable number are mechanical especially in young patients with rheumatic disease. The latter group is predominant in non-Caucasian populations where the rheumatic disease is the most common aetiology (4).In parallel, during the same years computed tomography (CT) scan technology evolved substantially offering excellent resolution and the ability to identify the commonest and most challenging complications of AVR (5). In particular, ECG-gated CT scan proved to be more reliable than echocardiography in identifying pannus, the most insidious long-term complication of mechanical valves. CT scan techniqueImages are usually acquired using retrospective ECGgated protocols with cardiac phase reconstruction at 5% to 10% RR interval increments. Both systolic (at 20% to 40% of RR interval) and diastolic phase (at 70% to 90% RR interval) are usually necessary. With these modalities, more than 90% of the valves can be accurately evaluated (6). As opposed to retrospective triggering, prospective ECG-gated protocols tend to generate less artifacts and require lesser radiation doses. However, they can be used only in patients with regular heart rate. When the patients are in atrial fibrillation, short acting beta-blockers can be used during the acquisition phase. However, with faster heart rates best results are obtained with dual source CT scan.CT data are reconstructed by a separate workstation for post-processing where oblique coronal or oblique sagittal images of the aortic root are assembled (Figure 1). By using a multiplanar image technique, profile and enface views of the prosthetic aortic valve showing the least amount of motion artifacts are generated. The presence or absence of a subprosthetic pannus is determined by the examiner as the appearance of a low-attenuation lesion or a calcified lesion Abstract: Obstruction of a mechanical aortic valve by pannus formation at the subvalvular level is a major long-term complication of aortic valve replacement (AVR). In fact, pannus is sometime difficult to differentiate from patient-prosthesis mismatch or valve thrombosis. In most cases cine-angiography and echocardiography, either transthoracic or transesophageal, cannot correctly visualize the complication when the leaflets show a normal mobility. Recent technological refinements made this difficult diagnosis possible by ECG-gated computed tomography (CT) scan which shows adequate images in 90% of the cases and can differentiate pannus from fresh and organized thrombus.

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“…Hounsfield unit of the lesions can be used to distinguish thromboses from panni, as panni tend to show higher attenuation. Gunduz et al [32] reported that thromboses could be distinguished from panni with high sensitivity (87.5%) and specificity (95.5%) using a cut-off point of 145 Hounsfield units. A pannus is shown as a soft tissue attenuated lesion with a circular anatomical configuration along the subvalvular area to the valve ring (Fig.…”

Section: Embolic Eventsmentioning

confidence: 99%

Postoperative Complications after Surgical Aortic Valve Replacement

Koo

Lee

Anh

et al. 2017

Cardiovasc Imaging Asia

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Aortic valve replacement is one of the most common major cardiac surgeries worldwide. Despite improvements in surgical techniques, postoperative complications after aortic valve surgery remain a source of substantial morbidity and mortality. Although transthoracic echocardiography and transesophageal echocardiography have been used for routine surveillance of prosthetic heart valves, computed tomography (CT) has played an important role with echocardiography in the diagnosis, treatment, and follow-up of patients after valve replacement. CT has the advantage of evaluating the extent of disease, such as paravalvular dehiscence, abscess, and pseudoaneurysm, in aortic prosthetic valves. In this article, we review the various image findings of postoperative complications after aortic valve replacement detected on CT.

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Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction

Cited by 101 publications

References 34 publications

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves

Postoperative Complications after Surgical Aortic Valve Replacement

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