Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Suh, Young Joo; Kim, Young Jin; Lee, Sak; Hong, Yoo Jin; Lee, Hye Jeong; Hur, Jin; Choi, Byoung Wook; Chang, Byung Chul

doi:10.1007/s10554-015-0683-1

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…In 17 patients with subaortic pannus on CT, aortic TMPG was significantly higher than in 71 patients without pannus (28.1±19.8 vs. 14.0±6.5 mmHg, P=0.004). Furthermore, cardiac CT has an important role in decision making for repeat AVR in symptomatic patients with moderate prosthetic AS and low-flow/ low-gradient phenomenon, 8 and for visual confirmation of subaortic pannus in patients without previous serial echocardiographic data. Additionally, mechanical mitral valve pannus formation, which is frequently associated with subaortic pannus, can be detected during routine preoperative CT for repeat cardiac surgery.…”

Section: Advance Publication By-j-stagementioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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Background: This study aimed to evaluate the early and late clinical outcomes after repeat aortic valve replacement (AVR) for subaortic pannus in patients with mechanical valves. Methods and Results:Between 2001 and 2017, 51 patients (median age, 59 years; 42 women) with prosthetic aortic stenosis (AS) caused by pannus ingrowth underwent repeat AVR because of acute malfunction of monoleaflet valve (3 patients), severe prosthetic AS (30 patients), and moderate prosthetic AS at the time of tricuspid or mitral valve surgery (18 patients). The median follow-up duration was 100 (interquartile range, 64-138) months. Double valve replacement was performed in 45 (88%) patients. Median time interval from previous operation was 161 (interquartile range, 121-194) months. The explanted mechanical AV was monoleaflet and bileaflet in 16 (31%) and 34 (67%) patients, respectively. Concomitant procedures included 16 mitral valve replacements (14 repeat) and 36 tricuspid valve surgeries (15 replacements, 21 repairs). No hospital deaths or cases of heart block occurred. Overall survival and event-free survival rates at 10 years were 88% and 51%, respectively. Late complications included recurrent prosthetic AS (4 patients), new paravalvular leakage of the mitral valve (5 patients), and severe tricuspid regurgitation (2 patients). Conclusions:Although repeat AVR for subaortic pannus had acceptable early and late survival, recurrent prosthetic AS was frequently observed during late follow-up.

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Section: Advance Publication By-j-stagementioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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“…No correlation has been found with the surgical technique or with inappropriate anticoagulation therapy. Conversely, patients with small body surface area (BSA) and small aortic annulus have shown a higher risk of severe obstruction, probably because even limited extension of pannus can cause a sizable reduction of GOA (12,20,23,24).…”

Section: Dealing With Pannusmentioning

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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“…For example, the commonly utilized Doppler echocardiography measures transvalvular flow velocities and pressure gradients that may reveal valvular obstruction. An abnormality detected on Doppler echocardiography can then be further investigated by ECG-gated computed tomography (CT) which, in addition to appreciating ring dehiscence (rocking displacement) on dynamic CT reconstruction, can be useful in validating valvular obstruction and its etiology (i.e., thrombus vs. pannus) [7,8]. Without the limitation of body habitus or operator proficiency as in echocardiography, ECG-gated CT allows the direct observation of valve leaflet mobility throughout the cardiac cycle by means of 4-dimensional (space and time) image reconstruction, termed cine-CT.…”

Section: Introductionmentioning

confidence: 99%

Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function

et al. 2020

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Background: After aortic valve replacement (AVR), suspected prosthetic valve dysfunction (mechanical or biological) may arise based on echocardiographic transvalvular velocities and gradients, leading to reoperative surgical intervention being considered. Our experience has found that 4-dimensional (space and time) image reconstruction of ECGgated computed tomography, termed cine-CT, may be helpful in such cases. We review and illustrate our experience. Methods: Twenty-seven AVR patients operated previously by a single surgeon (who performs > 100 AVRs/year) were referred for repeat evaluation of suspected aortic stenosis (AS) based on elevated transvalvular velocities and gradients. The patients were fully evaluated by cine-CT. Results: In all but 2 cases, the cine-CT strikingly and visually confirmed normal leaflet function and excursion, with no valve thrombosis, restriction by pannus, or obstruction by clot. In only 2 cases did cine-CT reveal decreased mechanical valve leaflet excursion. Repeat surgery was required in only 1 case while all other patients continued clinically without cardiac events. Conclusions: Echocardiography is an extraordinarily useful tool for the evaluation of prosthetic valve function. Increased pressure recovery beyond the valve and other factors may occasionally lead to exaggerated gradients. Cine-CT is emerging as an extremely valuable tool for further evaluation of suspected prosthetic valve AS. Our experience has been extremely helpful, as is shown in the dramatically reassuring images.

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Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

Cited by 10 publications

References 28 publications

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

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

Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function

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