Comparison of Multidetector-Row Computed Tomography to Echocardiography and Fluoroscopy for Evaluation of Patients with Mechanical Prosthetic Valve Obstruction

OBJECTIVES: For evaluation of prosthetic heart valve obstruction echocardiography and fluoroscopy provide primarily functional information, but may not unequivocally establish the cause of dysfunction. Our objective was to evaluate whether multidetector-row computed tomographic (MDCT) imaging could detect the morphologic substrate for such functional abnormalities.

METHODS: Thirteen patients with 15 prosthetic valves, in whom prosthetic valve obstruction was suspected from echocardiography or fluoroscopy, but no sufficient cause could be found, underwent electrocardiographically gated multidetector-row computed tomography. MDCT data were retrospectively reconstructed at every 10% of the electrocardiographic interval and analyzed using multiplanar reformatting in anatomically adapted planes. MDCT images were evaluated for morphologic prosthetic and periprosthetic abnormalities.

RESULTS: Results could be compared to intraoperative findings or autopsy in 7 patients. Multidetector-row computed tomography disclosed a morphologic substrate for obstruction in 8 of 13 patients. MDCT findings compatible with obstruction were confirmed at surgery or autopsy in 6 patients. In a seventh patient, incomplete leaflet closure found with multidetector-row computed tomography was confirmed at surgery. The most commonly identified causes for obstruction were subprosthetic tissue (6 patients) and abnormal anatomic orientation (3 patients). Despite an indication for surgery, 2 patients were not operated on due to recurrent bacteremias and prohibitive co-morbidity. Multidetector-row computed tomography detected leaflet motion restriction in 7 patients compared to 4 by fluoroscopy. Confirmation of leaflet restriction was available in 5 patients. Multidetector-row computed tomography missed a periprosthetic leak.

CONCLUSIONS: In conclusion, this initial experience demonstrates that multidetector-row computed tomography can identify causes of prosthetic valve obstruction that constitute indications for surgery, but are missed at echocardiography or fluoroscopy. Alvin Kamara Authentic Jersey

PMID: 19801036

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  1. Initial experience of using MDCT in prosthetic valve dysfunction:
    Although, the sample size is small, the clinical relevance of this study is large. What I find most attractive about use of MDCT in this setting is its ability to detect subprosthetic pannus formation (tissue in-growth), a finding which is difficult to define echocardiographically.

  2. See also:

    Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients.
    Habets J, Symersky P, van Herwerden LA, de Mol BA, Spijkerboer AM, Mali WP, Budde RP.
    Eur Radiol. 2011 Jan 29.

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