Abstract 13031: Real-Time Three-Dimensional Transesophageal Echocardiography for Diagnosis of Pannus Formation in Mechanical Aortic Valves: Comparison with Multi-detector Computed Tomography and Surgical Findings
Introduction: Pannus formation is a rare but important complication that can be missed in patients with prosthetic valves. However, currently available methodologies are not sufficient to diagnose subvalvular pannus formation especially in mechanical aortic valves.
Hypothesis: In this study, we explored a series of experiences with three-dimensional transesophageal echocardiography (3D-TEE) for the visualization and accurate assessment of subvalvular pannus in patients with mechanical aortic valve.
Methods: We enrolled 11 patients (mean age 64±8.6 years, 10 patients with either double or triple valve replacement) who had previously implanted mechanical aortic valve, with transaortic mean pressure gradient >40mmHg or transaortic maximal velocity >4m/sec despite normal occluder motion. All patients underwent 3D-TEE examination to rule out pannus formation and these findings were compared with multi-detector computed tomography (MDCT) images and/or surgical findings.
Results: In 10 patients, 3D-TEE allowed good visualization of subaortic pannus formation whereas there was no significant pannus ingrowth in one patient. Through cropping full-volume 3D-TEE images, subaortic pannus formation could be visualized well in en face view, which was confirmed by MDCT images. The 3D-TEE images of the pannus were also matched with intraoperative findings in 7 patients undergoing reoperation of the mechanical aortic valve (Figure). Quantitative measurement of geometric subvalvular area using 3D planimetry was feasible and correlated well with the area measured by MDCT and with transaortic mean pressure gradient on transthoracic echocardiography (Spearman’s ρ=0.761 and -0.726, all p-value<0.05).
Conclusions: Real-time 3D-TEE is a useful diagnostic tool for the anatomical assessment of subvalvular pannus formation in mechanical aortic valves.
Author Disclosures: S. Lee: None. S. Lee: None. E. Park: None. M. Hong: None. J. Kim: None. H. Yang: None. H. Kim: None. W. Lee: None. Y. Kim: None. D. Sohn: None.
- © 2014 by American Heart Association, Inc.