Abstract 15264: Additional Value of Cardiac Computed Tomogragraphy to Assess Prosthetic Valvular Dysfunctions
To evaluate the potential contribution of cardiac multidetector computed tomography (MDCT) to assess prosthetic valve (PV) dysfunctions, we included 38 patients with PV who underwent echoDoppler (TTE +/- TEE) and cardiac MDCT within 2 days or less. A total of 50 PV were explored including 23 mechanical and 17 biological PV. They were 31 in aortic, 16 in mitral, 1 in pulmonary, 2 in tricuspid position. According to TTE +/- TEE, 3 groups of PV were defined: normal, stenotic, and regurgitant. MDCT images were analysed by 2 radiologists blinded to each other’s and to TTE +/- TEE. The results were compared to surgical data, when available (n = 16). PV function was considered abnormal at MDCT in 29 cases: limitation in the opening (12) or in the closure (2) of the leaflets, annular tilting (8), calcification of leaflets (4), protrusive calcification of the ring (7), aspect of suture loosening (12), thrombosis (2) or pannus (4) . In the normal group (n=27), MDCT found abnormalities in 6 cases: calcifications or subprosthetic pannus (3); abscesses with extension to the aorto-mitral trigone (3) or pseudoaneurysm (1). 3 out of these 6 patients were operated on and MDCT data was confirmed at surgery. In the stenotic group (n=15), MDCT was abnormal in 11 and normal in 3 cases. Among these 3 cases, pannus and subvalvular membrane were demonstrated at surgery in 1. In the regurgitant group (n=8), MDCT was abnormal in all cases. Para-valvular pseudoaneurysms, aspect of suture loosening or annular tilting in MDCT were associated to paraprosthetic leak in TTE+/-TEE. MDCT showed PV dysfunctions in 22 out of the 23 cases demonstrated in TTE+/-TEE, it provided additional information about the mechanism in 10. MDCT demonstrated significant lesions confirmed by surgery on PV considered as normal according to EchoDoppler data in 3. MDCT is becoming a reliable and problem resolving complimentary technique in analysing prosthetic valve dysfunction. A learning curve is still to consider.
- © 2012 by American Heart Association, Inc.