Abstract
The purpose was to compare the findings of multi-detector computed tomography (MDCT) in prosthetic valve disorders using the operative findings as a gold standard. In a 3-year period, we prospectively enrolled 25 patients with 31 prosthetic heart valves. MDCT and transthoracic echocardiography (TTE) were done to evaluate pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and pseudoaneurysm formation. Patients indicated for surgery received an operation within 1 week. The MDCT findings were compared with the operative findings. One patient with a Björk-Shiley valve could not be evaluated by MDCT due to a severe beam-hardening artifact; thus, the exclusion rate for MDCT was 3.2% (1/31). Prosthetic valve disorders were suspected in 12 patients by either MDCT or TTE. Six patients received an operation that included three redo aortic valve replacements, two redo mitral replacements and one Amplatzer ductal occluder occlusion of a mitral paravalvular leak. The concordance of MDCT for diagnosing and localizing prosthetic valve disorders and the surgical findings was 100%. Except for images impaired by severe beam-hardening artifacts, MDCT provides excellent delineation of prosthetic valve disorders.
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This research was supported in part by Taichung Veterans General Hospital under grants TCVGH-975506C and TCVGH-975504A.
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Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as the gold standard
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Animation 4a
Three-chamber view of TTE showing normal prosthetic bileaflet valve motion. See Fig. 4a for annotation. Compared with animation 4c, the loosening regions of the prosthetic aortic valve were all blocked by the acoustic shadowing caused by the prosthesis itself (MPG 355 kb)
Three-chamber view of MDCT clearly demonstrating the loosening region near the fibrous continuity between the mitral and aortic valves. During systole, the valve is displaced superiorly, exposing the loosening defect. See Fig. 4c for annotation (MPG 522 kb)
Animation 5a
Serial MDCT images of the left ventricular outflow tract. The pannus (red arrows) is identified as a small black area just below the suture ring extending into the housing. The pannus is formed extensively, involving all three zones (MPG 1762 kb)
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Tsai, IC., Lin, YK., Chang, Y. et al. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol 19, 857–867 (2009). https://doi.org/10.1007/s00330-008-1232-2
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DOI: https://doi.org/10.1007/s00330-008-1232-2