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Panchal A, Khalil R, Lygouris G, Biederman R, Kyvernitakis A. Acute Severe Aortic Regurgitation From Catastrophic Pannus Obstruction in a Patient With Mechanical Aortic Valve Replacement. Cureus 2022; 14:e27198. [PMID: 36035046 PMCID: PMC9397150 DOI: 10.7759/cureus.27198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
A 69-year-old woman with a mechanical aortic valve presented with decompensated heart failure. Emergent echocardiogram and fluoroscopy demonstrated acute aortic regurgitation due to a dysfunctional mechanical aortic valve and non-obstructive coronary disease. An emergent valve replacement was performed confirming a fixed-open valve with pathology demonstrating obstructive pannus formation without thrombosis or vegetation.
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Scherman J, Zilla P. Poorly suited heart valve prostheses heighten the plight of patients with rheumatic heart disease. Int J Cardiol 2020; 318:104-114. [DOI: 10.1016/j.ijcard.2020.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
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Park MY, Koo HJ, Ha H, Kang JW, Yang DH. Extent of Subprosthetic Pannus after Aortic Valve Replacement: Changes Over Time and Relationship with Echocardiographic Findings. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1151-1163. [PMID: 36238048 PMCID: PMC9431869 DOI: 10.3348/jksr.2019.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022]
Abstract
Purpose This study aimed to evaluate changes of subprosthetic pannus on cardiac CT and determine its relationship to echocardiographic findings in patients with mechanical aortic valve replacement (AVR). Materials and Methods Between April 2011 and November 2017, 17 AVR patients (56.8 ± 8.9 years, 12% male) who showed pannus formation on CT and had undergone both follow-up CT and echocardiography were included. The mean interval from AVR to the date of pannus detection was 10.5 ± 7.1 years. In the initial and follow-up CT and echocardiography, the pannus extent and echocardiographic parameters were compared using paired t-tests. The relationship between the opening angle of the prosthetic valve and the pannus extent was evaluated using Pearson correlation analysis. Results The pannus extent was significantly increased on CT (p < 0.05). The peak velocity (3.9 ± 0.8 m/s vs. 4.2 ± 0.8 m/s, p = 0.03) and mean pressure gradient (36.4 ± 15.5 mm Hg vs. 42.1 ± 15.8 mm Hg, p = 0.03) were significantly increased. The mean opening angles of the mechanical aortic leaflets were slightly decreased, but there was no statistical significance (73.1 ± 8.3° vs. 69.4 ± 12.1°, p = 0.12). The opening angle of the prosthetic leaflets was inversely correlated with the pannus extent (r = −0.57, p < 0.001). Conclusion The pannus extent increases over time, increasing transvalvular peak velocity and the pressure gradient. CT can be used to evaluate the pannus extent associated with hemodynamic changes that need to be managed by surgical intervention.
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Affiliation(s)
- Mi Yeon Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center, Seoul, Korea
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center, Seoul, Korea
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Park PW, Park B, Jeong DS, Sung K, Kim WS, Lee YT, Park SW. Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve. Circ J 2018; 82:2535-2541. [DOI: 10.1253/circj.cj-18-0352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Koo HJ, Ha H, Kang JW, Kim JA, Song JK, Kim HJ, Lim TH, Yang DH. Impact of pannus formation on hemodynamic dysfunction of prosthetic aortic valve: pannus extent and its relationship to prosthetic valve motion and degree of stenosis. Clin Res Cardiol 2018; 107:554-564. [DOI: 10.1007/s00392-018-1217-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/14/2018] [Indexed: 01/17/2023]
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Koo HJ, Lee HN, Anh TT, Kang JW, Yang DH, Song JK, Kang DH, Song JM, Lee JW, Chung CH, Choo SJ, Lim TH. Postoperative Complications after Surgical Aortic Valve Replacement. ACTA ACUST UNITED AC 2017. [DOI: 10.22468/cvia.2017.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Na Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Tran ThiXuan Anh
- Department of Cardiology, University Medical Center, Ho Chi Minh, Vietnam
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Suk-Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Suchá D, Symersky P, van den Brink RB, Tanis W, Laufer EM, Meijs MF, Habets J, de Mol BA, Mali WP, Chamuleau SA, van Herwerden LA, Budde RP. Diagnostic evaluation and treatment strategy in patients with suspected prosthetic heart valve dysfunction: The incremental value of MDCT. J Cardiovasc Comput Tomogr 2016; 10:398-406. [DOI: 10.1016/j.jcct.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
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9
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Suh YJ, Lee S, Im DJ, Chang S, Hong YJ, Lee HJ, Hur J, Choi BW, Chang BC, Shim CY, Hong GR, Kim YJ. Added value of cardiac computed tomography for evaluation of mechanical aortic valve: Emphasis on evaluation of pannus with surgical findings as standard reference. Int J Cardiol 2016; 214:454-60. [DOI: 10.1016/j.ijcard.2016.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/11/2016] [Accepted: 04/02/2016] [Indexed: 12/12/2022]
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Abstract
Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis. For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac infections. Evidence for the additional value of 3D-TEE is scarce. As clinical implications are major, clinicians should have a low threshold to perform additional MDCT in acquired mechanical PHV obstruction. For suspected PHV endocarditis, both FDG-PET and MDCT have complementary value.
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Salamon J, Munoz-Mendoza J, Liebelt JJ, Taub CC. Mechanical valve obstruction: Review of diagnostic and treatment strategies. World J Cardiol 2015; 7:875-881. [PMID: 26730292 PMCID: PMC4691813 DOI: 10.4330/wjc.v7.i12.875] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/22/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO.
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12
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Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings. J Am Soc Echocardiogr 2015; 28:1131-48. [DOI: 10.1016/j.echo.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/22/2022]
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13
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Suchá D, Symersky P, Tanis W, Mali WP, Leiner T, van Herwerden LA, Budde RP. Multimodality Imaging Assessment of Prosthetic Heart Valves. Circ Cardiovasc Imaging 2015; 8:e003703. [DOI: 10.1161/circimaging.115.003703] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as new potential imaging modalities for valve prostheses. We present an overview of the possibilities and pitfalls of CT and MRI for PHV assessment based on a systematic literature review of all experimental and patient studies. For this, a comprehensive systematic search was performed in PubMed and Embase on March 24, 2015, containing CT/MRI and PHV synonyms. Our final selection yielded 82 articles on surgical valves. CT allowed adequate assessment of most modern PHVs and complemented echocardiography in detecting the obstruction cause (pannus or thrombus), bioprosthesis calcifications, and endocarditis extent (valve dehiscence and pseudoaneurysms). No clear advantage over echocardiography was found for the detection of vegetations or periprosthetic regurgitation. Whereas MRI metal artifacts may preclude direct prosthesis analysis, MRI provided information on PHV-related flow patterns and velocities. MRI demonstrated abnormal asymmetrical flow patterns in PHV obstruction and allowed prosthetic regurgitation assessment. Hence, CT shows great clinical relevance as a complementary imaging tool for the diagnostic work-up of patients with suspected PHV obstruction and endocarditis. MRI shows potential for functional PHV assessment although more studies are required to provide diagnostic reference values to allow discrimination of normal from pathological conditions.
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Affiliation(s)
- Dominika Suchá
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Petr Symersky
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - W. Tanis
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Willem P.Th.M. Mali
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Tim Leiner
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Lex A. van Herwerden
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Ricardo P.J. Budde
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
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Teshima H, Ikebuchi M, Sano T, Kinugasa Y, Tai R, Irie H. A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography. J Artif Organs 2015; 18:373-6. [PMID: 26105106 DOI: 10.1007/s10047-015-0850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022]
Abstract
A 62-year-old female patient underwent mitral valve replacement with a 31/33-mm On-X valve for ischemic mitral valve regurgitation. Three months later, transthoracic echocardiography incidentally showed a blocked leaflet with 6 mmHg of mean pressure gradient and 2.4 cm(2) of mitral valve orifice area. Transesophageal echocardiography could not detect thrombus. Electrocardiographically gated multidetector-row computed tomography (MDCT) clearly demonstrated a blocked leaflet in the close position and thrombus (2 cm in length, 0.4 cm(2) in area) attached onto the atrial aspect of the leaflet. These findings observed by MDCT were confirmed at reoperation. MDCT was useful diagnostic method for visualizing prosthetic valve thrombosis.
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Affiliation(s)
- Hideki Teshima
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan.
| | - Masahiko Ikebuchi
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan
| | - Toshikazu Sano
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan
| | - Yusuke Kinugasa
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan
| | - Ryuta Tai
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan
| | - Hiroyuki Irie
- Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan
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Abstract
OBJECTIVE The purpose of this article is to review the utility of ECG-gated MDCT in evaluating postsurgical findings in aortic and mitral valves. Normal and pathologic findings after aortic and mitral valve corrective surgery are shown in correlation with the findings of the traditionally used imaging modalities echocardiography and fluoroscopy to assist in accurate noninvasive anatomic and dynamic evaluation of postsurgical valvular abnormalities. CONCLUSION Because of its superior spatial and adequate temporal resolution, ECG-gated MDCT has emerged as a robust diagnostic tool in the evaluation and treatment of patients with postsurgical valvular abnormalities.
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16
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Evaluation of advancing the standard valve dysfunction by multidetector-row CT. J Artif Organs 2014; 17:162-8. [DOI: 10.1007/s10047-013-0751-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
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17
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Tanis W, Habets J, van den Brink RBA, Symersky P, Budde RPJ, Chamuleau SAJ. Differentiation of thrombus from pannus as the cause of acquired mechanical prosthetic heart valve obstruction by non-invasive imaging: a review of the literature. Eur Heart J Cardiovasc Imaging 2013; 15:119-29. [DOI: 10.1093/ehjci/jet127] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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18
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Sun Z, Almoudi M. Coronary computed tomography angiography: an overview of clinical applications. Interv Cardiol 2013. [DOI: 10.2217/ica.12.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pham N, Zaitoun H, Mohammed TL, DeLaPena-Almaguer E, Martinez F, Novaro GM, Kirsch J. Complications of Aortic Valve Surgery: Manifestations at CT and MR Imaging. Radiographics 2012; 32:1873-92. [DOI: 10.1148/rg.327115735] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Willson AB, Webb JG, Gurvitch R, Wood DA, Toggweiler S, Binder R, Freeman M, Madden M, Hague C, Leipsic J. Structural Integrity of Balloon-Expandable Stents After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2012; 5:525-532. [DOI: 10.1016/j.jcin.2012.03.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/29/2012] [Accepted: 03/15/2012] [Indexed: 11/26/2022]
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Habets J, Symersky P, Leiner T, de Mol BAJM, Mali WPTM, Budde RPJ. Artifact reduction strategies for prosthetic heart valve CT imaging. Int J Cardiovasc Imaging 2012; 28:2099-108. [PMID: 22476910 PMCID: PMC3485534 DOI: 10.1007/s10554-012-0041-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/16/2012] [Indexed: 12/19/2022]
Abstract
Multislice CT evaluation of prosthetic heart valves (PHV) is limited by PHV-related artifacts. We assessed the influence of different kV settings, a metal artifact reduction filter (MARF) and an iterative reconstruction algorithm (IR) on PHV-induced artifacts in an in vitro model. A Medtronic-Hall tilting disc and St Jude bileafet PHV were imaged using a 64-slice scanner with 100 kV/165 mAs, 120 kV/100 mAs, 140 kV/67 mAs at an equal CTDI(vol). Images were reconstructed with (1) filtered back projection (FBP), (2) IR, (3) MARF and (4) MARF and IR. Hypo- and hyperdense artifacts volumes (mean mm(3) ± SD) were quantified with 2 thresholds (≤-50 and ≥175 Hounsfield Units). Image noise was measured and the presence of secondary artifacts was scored by 2 observers independently. Mean hypodense artifacts for the Medtronic-Hall/St Jude valve (FBP) were 966 ± 23/1,738 ± 21 at 100 kV, 610 ± 13/991 ± 12 at 120 kV, and 420 ± 9/634 ± 9 at 140 kV. Compared to FBP, hypodense artifact reductions for IR were 9/8 %, 10/7 % and 12/6 % respectively, for MARF 92 %/84 %, 89/81 % and 86/77 % respectively; for MARF + IR 94/85 %, 92/82 %, and 90/79 % respectively. Mean hyperdense artifacts for the Medtronic-Hall/St Jude valve were 5,530 ± 48/6,940 ± 70 at 100 kV, 5,120 ± 42/6,250 ± 53 at 120 kV, and 5,011 ± 52/6,000 ± 0 at 140 kV. Reductions for IR were 2/2 %, 2/3 % and 3/4 % respectively, for MARF were 9/30 %, 0/25 %, 5/22 % respectively, MARF + IR 12/32 %, 4/27 % and 7/25 % respectively. Secondary artifacts were found in all MARF images. Image noise was reduced in the IR images. In vitro PHV-related artifacts can be reduced by increasing kV despite maintaining identical CTDI(vol). Although MARF is more effective than IR, it induces secondary artifacts.
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Affiliation(s)
- Jesse Habets
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands.
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Symersky P, Habets J, Westers P, de Mol BAJM, Prokop M, Budde RPJ. Prospective ECG triggering reduces prosthetic heart valve-induced artefacts compared with retrospective ECG gating on 256-slice CT. Eur Radiol 2011; 22:1271-7. [PMID: 22205446 PMCID: PMC3348472 DOI: 10.1007/s00330-011-2358-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 11/20/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Multidetector computed tomography (MDCT) has diagnostic value for the evaluation of prosthetic heart valve (PHV) dysfunction but it is hampered by artefacts. We hypothesised that image acquisition using prospective triggering instead of retrospective gating would reduce artefacts related to pulsating PHV. METHODS In a pulsatile in vitro model, a mono- and bileaflet PHV were imaged using 256 MDCT at 60, 75 and 90 beats per minute (BPM) with either retrospective gating (120 kV, 600 mAs, pitch 0.2, CTDI(vol) 39.8 mGy) or prospective triggering (120 kV, 200 mAs, CTDI(vol) 13.3 mGy). Two thresholds (>175 and <-45HU), derived from the density of surrounding structures, were used for quantification of hyper- and hypodense artefacts. Image noise and artefacts were compared between protocols. RESULTS Prospective triggering reduced hyperdense artefacts for both valves at every BPM (P = 0.001 all comparisons). Hypodense artefacts were reduced for the monoleaflet valve at 60 (P = 0.009), 75 (P = 0.016) and 90 BPM (P = 0.001), and for the bileaflet valves at 60 (P = 0.001), 90 (P = 0.001) but not at 75 BPM (P = 0.6). Prospective triggering reduced image noise at 60 (P = 0.001) and 75 (P < 0.03) but not at 90 BPM. CONCLUSIONS Compared with retrospective gating, prospective triggering reduced most artefacts related to pulsating PHV in vitro. KEY POINTS • Computed tomographic images are often degraded by prosthetic heart valve-induced artefacts • Prospective triggering reduces prosthetic heart valve-induced artefacts in vitro • Artefact reduction at 90 beats per minute occurs without image noise reduction • Prospective triggering may improve CT image quality of moving hyperdense structures.
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Affiliation(s)
- Petr Symersky
- Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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23
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Sun Z. Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations. Front Med 2011; 5:254-70. [DOI: 10.1007/s11684-011-0153-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Abstract
Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these techniques sometimes fail to determine the specific cause of PHV dysfunction, which is crucial to the selection of the appropriate treatment strategy. Multidetector-row CT (MDCT) can be of additional value in diagnosing the specific cause of PHV dysfunction and provides valuable complimentary information for surgical planning in case of reoperation. Cardiac magnetic resonance imaging (CMR) has limited value in the evaluation of biological PHV dysfunction. In this Review, we discuss the use of established imaging modalities for the detection of left-sided mechanical and biological PHV dysfunction and discuss the complementary role of MDCT in this context.
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Multidetector CT imaging of mechanical prosthetic heart valves: quantification of artifacts with a pulsatile in-vitro model. Eur Radiol 2011; 21:2103-10. [PMID: 21573762 PMCID: PMC3165133 DOI: 10.1007/s00330-011-2146-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/15/2011] [Accepted: 04/27/2011] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Multidetector computed tomography (MDCT) can detect the cause of prosthetic heart valve (PHV) dysfunction but is hampered by valve-induced artifacts. We quantified artifacts of four PHV using a pulsatile in-vitro model and assessed the relation to leaflet motion and valve design. METHODS A Medtronic Hall tilting disc (MH), and Carbomedics (CM), St Jude (SJM), and ON-X bileaflet valves underwent CT in an in-vitro model using retrospective gating with a 64 detector CT system in stationary and pulsatile conditions. Artifacts and radiopaque component volumes were quantified with thresholds based on surrounding structures and valvular components. RESULTS Hypodense artifacts volumes (mm³) were 1,029 ± 147, 535 ± 53, 371 ± 16, and 366 ± 18 for the SJM, MH, CM and ON-X valves (p < 0.001 except for the latter two valves p = 0.43). Hyperdense artifact volumes were 3,546 ± 141, 2,387 ± 103, 2,003 ± 102, and 3,033 ± 31 for the SJM, MH, CM and ON-X valve, respectively (all differences p < 0.001). Leaflet motion affected hypodense (F = 41.5, p < 0.001) and hyperdense artifacts (F = 53.7, p < 0.001). Closed and moving leaflets were associated with the least and the most artifacts respectively (p < 0.001, both artifact types). CONCLUSION Both valve design and leaflet motion affect PHV-induced artifacts. Best imaging results may be expected for the CM valve during phases in which the leaflets are closed.
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Firstenberg MS, Raman SV, Dickerson J. Noninvasive imaging of prosthetic cardiac devices. Expert Rev Cardiovasc Ther 2011; 9:381-94. [PMID: 21438817 DOI: 10.1586/erc.11.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The major advances in cardiovascular care can be linked to the combined growth of advanced imaging modalities and the variety of treatment options available for patients with complex structural, acquired and congenital, valvular, myocardial and aortic diseases. Paralleling this growth are the number and spectrum of complications - such as device failures and infections - that these patients will inevitably encounter. The keys to successful implementation of advanced cardiac therapy are the real-time images, 3D reconstructions, and the hemodynamic and tissue profiles that can be obtained to evaluate these patients and their devices. We will review the roles of echocardiography, multidetector computed tomography and MRI in the evaluation of normal and abnormal cardiac device function.
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Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients. Eur Radiol 2011; 21:1390-6. [PMID: 21279515 PMCID: PMC3101341 DOI: 10.1007/s00330-011-2068-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/26/2010] [Accepted: 12/12/2010] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Multidetector CT (MDCT) has shown potential for prosthetic heart valve (PHV) assessment. We assessed the image quality of different PHV types to determine which valves are suitable for MDCT evaluation. METHODS All ECG-gated CTs performed in our institutions since 2003 were reviewed for the presence of PHVs. After reconstruction in 3 specific PHV planes, image quality of the supravalvular, perivalvular, subvalvular and valvular regions was scored on a four-point scale (1 = non-diagnostic, 2 = moderate, 3 = good and 4 = excellent) by two independent observers. RESULTS Eighty-four CT examinations (66 cardiac, 18 limited-dose aortic protocols) of 83 patients with a total of 91 PHVs in the aortic (n = 71), mitral (n = 17), pulmonary (n = 1) and tricuspid (n = 2) position were included. CT was performed on a 16-slice (n = 4), 64-slice (n = 28) or 256-slice (n = 52) MDCT system. Median image quality scores for the supra-, peri- and subvalvular regions and valvular detail were (3.5, 3.3, 3.5 and 3.5, respectively) for bileaflet PHV; (3.0, 3.0, 3.5 and 3.0, respectively) for Medtronic Hall PHV; (1.0, 1.0, 1.0 and 1.0, respectively) for Björk-Shiley and Sorin monoleaflet PHV and (3.5, 3.5, 4.0 and 2.0 respectively) for biological PHV. CONCLUSION Currently implanted PHVs have good image quality on MDCT and are suitable for MDCT evaluation.
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28
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Moon D, Lee JW, Kim YS, Cho WC, Jung SH, Choo SJ, Chung CH. Midterm Results of Aortic Valve Replacement Using Tissue Valve. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dukhwan Moon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, The Army Armed Forces Hampyung Hospital
| | - Won-Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Suk-Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Cheol-Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Hurwitz SE, Waxman D, Hecht S. Acute failure of a St. Jude's prosthetic aortic valve: large pannus formation masked by a small thrombus. J Am Soc Echocardiogr 2009; 22:1086.e1-3. [PMID: 19733796 DOI: 10.1016/j.echo.2009.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Indexed: 10/20/2022]
Abstract
Pannus formation and valve thrombus can cause prosthetic valve failure. The authors report the case of a 50-year-old woman who presented to the emergency room with decompensated heart failure secondary to mechanical valve dysfunction. On two-dimensional and transesophageal echocardiography, the patient had severe aortic stenosis and regurgitation. A thrombus seen on the valve was felt to be the etiology of her prosthetic valve failure. She underwent emergent cardiac surgery for aortic valve replacement. Pathology revealed that although a small thrombus was present, extensive pannus was the underlying mechanism of valve dysfunction. Differentiation between pannus and thrombus may have important clinical implications, but this case illustrates that distinguishing between these entities by echocardiographic and clinical criteria may not be possible.
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Affiliation(s)
- Seth Eric Hurwitz
- Department of Medicine, Beth Israel Medical Center, New York, NY 10003, USA.
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30
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Symersky P, Budde RPJ, de Mol BAJM, Prokop M. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol 2009; 104:1128-34. [PMID: 19801036 DOI: 10.1016/j.amjcard.2009.05.061] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 11/16/2022]
Abstract
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. 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 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. 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.
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Affiliation(s)
- Petr Symersky
- Department of Cardiothoracic Surgery, Isala Klinieken, Zwolle, The Netherlands.
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31
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Giroux SK, Labinaz MX, Grisoli D, Klug AP, Veinot JP, Burwash IG. Intermittent, noncyclic dysfunction of a mechanical aortic prosthesis by pannus formation. J Am Soc Echocardiogr 2009; 23:107.e1-3. [PMID: 19762209 DOI: 10.1016/j.echo.2009.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Indexed: 11/16/2022]
Abstract
Mechanical aortic prosthesis dysfunction can result from thrombosis or pannus formation. Pannus formation usually restricts systolic excursion of the occluding disk, resulting in progressive stenosis of the aortic prosthesis. Intermittent dysfunction of a mechanical aortic prosthesis is usually ascribed to thrombus formation. We describe an unusual case of intermittent, noncyclic dysfunction of a mechanical aortic prosthesis due to pannus formation in the absence of systolic restriction of disk excursion that presented with intermittent massive aortic regurgitation, severe ischemia, and shock. Pannus formation should be considered as a potential cause of acute intermittent severe aortic regurgitation in a patient with a mechanical aortic prosthesis.
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Affiliation(s)
- Sylvie K Giroux
- Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
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Feuchtner GM. The utility of computed tomography in the context of aortic valve disease. Int J Cardiovasc Imaging 2009; 25:611-4. [PMID: 19468861 DOI: 10.1007/s10554-009-9472-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/20/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Gudrun M Feuchtner
- Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
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33
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Management of prosthetic heart valve obstruction: Fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases. Arch Cardiovasc Dis 2009; 102:269-77. [DOI: 10.1016/j.acvd.2009.01.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 01/26/2009] [Accepted: 01/26/2009] [Indexed: 11/21/2022]
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Zilla P, Brink J, Human P, Bezuidenhout D. Prosthetic heart valves: Catering for the few. Biomaterials 2008; 29:385-406. [DOI: 10.1016/j.biomaterials.2007.09.033] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 09/23/2007] [Indexed: 01/17/2023]
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Aslam AK, Aslam AF, Vasavada BC, Khan IA. Prosthetic heart valves: Types and echocardiographic evaluation. Int J Cardiol 2007; 122:99-110. [PMID: 17434628 DOI: 10.1016/j.ijcard.2006.12.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 12/15/2006] [Accepted: 12/30/2006] [Indexed: 11/30/2022]
Abstract
In the last five decades multiple different models of prosthetic valves have been developed. The purpose of this article is to provide a comprehensive source of information for the types and the echocardiographic evaluation of the prosthetic heart valves.
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Affiliation(s)
- Ahmad Kamal Aslam
- Division of Cardiology, Beth Israel Medical Center, 16th Street 1st Avenue, New York, NY 10003, USA.
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36
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Nouette K, Richebé P, Calderon J, Mouton C, Janvier G. [Perioperative anticoagulation management for prosthetic heart valves]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:621-31. [PMID: 15908168 DOI: 10.1016/j.annfar.2005.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Accepted: 02/26/2005] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The practices and the guidelines over the perioperative management of the anticoagulation of patients with cardiac valves prothesis are the object of no consensual attitude. The thrombotic risk over the time is well known. It depends of the type or the location on the valve, of their associations and the age of the patient. In the perioperative period, the antithrombotic treatment must be interrupted according to the surgical haemorrhagic risk. STUDY DESIGN Short review. RESULTS Only patients, without associated risk factor, carriers of bioprosthesis from more than 3 months, can be maintained only under antiplatelets agents. In others situations, the caution imposes a bridge of anticoagulants from 48 to 72 hours with unfractionated heparin (subcutaneous at home, intravenous at the hospital). Low molecular weight heparin has no commercial authorization in this indication. The resumption of the anticoagulation by unfractionated heparin in postoperative period must be the most premature possible after the decrease of the surgical bleeding. The relay by vitamin K antagonists has to be made over 48 to 72 hours. Within the framework of the urgency, the surgical haemorrhagic risk is weak for an INR <1.5. According to the urgency of the surgery, a treatment by vitamin K (if the delay is over 12 hours) or by prothrombinic complex allows to correct this INR. The identification of thrombotic complications requires a particular attention. In the postoperative period, as soon as there is suspicion of thrombosis, clinical manifestations must be consolidated by the practice of a transoesophageal echography, which only confirm the diagnosis.
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Affiliation(s)
- K Nouette
- Fédération d'anesthésie-réanimation chirurgicale, CHU de Bordeaux, groupe hospitalier Sud, 33604 Pessac cedex, France
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Walters DL, Sanchez PL, Rodriguez-Alemparte M, Colon-Hernandez PJ, Hourigan LA, Palacios IF. Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: the Massachusetts General Hospital experience, 1989-2000. Catheter Cardiovasc Interv 2003; 58:539-44. [PMID: 12652508 DOI: 10.1002/ccd.10473] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Accurate assessment of suspected prosthetic valve dysfunction is critically important as reoperation carries high risk. Noninvasive methods of hemodynamic assessment of patients with both aortic and mitral mechanical valves continue to be frustrated by the interference created by prosthetic material and direct left ventricular puncture may be required for definitive hemodynamic assessment. We report the hemodynamic and angiographic results and outcomes of 38 consecutive patients with double valve replacement who underwent left ventricular puncture as part of evaluation of possible prosthetic dysfunction. These results were compared with those obtained by noninvasive testing. We found noninvasive assessment alone to be unsatisfactory as measurements of regurgitation and stenosis correlated poorly with those obtained by direct left ventricular puncture. Important information that altered patient management was obtained from invasive assessment in 68% of cases with an acceptable rate of complications. Therefore, hemodynamic and angiographic assessment using transthoracic left ventricular puncture should be entertained in patients with mitral and aortic valve replacement presenting with congestive heart failure and suspected prosthesis dysfunction.
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Affiliation(s)
- Darren L Walters
- Cardiology Division, Medical Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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38
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Montorsi P, Teruzzi G, Calligaris G. Non invasive assessment of mechanical valve obstruction. Catheter Cardiovasc Interv 2002; 57:410-1; author reply 411. [PMID: 12410524 DOI: 10.1002/ccd.10337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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39
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Licata A. Reply to the letter. Catheter Cardiovasc Interv 2002. [DOI: 10.1002/ccd.10338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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40
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Licata A, Matthai WH. Evaluating the etiology of mechanical valve obstruction: use of clinical parameters, fluoroscopy, and echocardiography. Catheter Cardiovasc Interv 2002; 55:495-500. [PMID: 11948898 DOI: 10.1002/ccd.10096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prosthetic valve obstruction is a life-threatening complication most commonly caused by thrombus, pannus, or both. We report a St. Jude tricuspid valve obstruction, initially treated with thrombolytic therapy, found to be caused by pannus on pathologic examination. Clinical evaluation and diagnostic evaluation with fluoroscopy and echocardiography in distinguishing pannus from thrombus are reviewed.
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Affiliation(s)
- Anthony Licata
- Division of Cardiovascular Medicine, University of Pennsylvania Medical School, Philadelphia, Pennsylvania 19104, USA.
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