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

P. Symersky, R.P.J. Budde, B.A.J.M. Mol, de, M. Prokop

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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. © 2009 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1128-1134
Number of pages7
JournalAmerican Journal of Cardiology
Volume104
Issue number8
DOIs
Publication statusPublished - 2009

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Multidetector Computed Tomography
Fluoroscopy
Echocardiography
Autopsy
Heart Valves
Bacteremia
Morbidity

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title = "Comparison of Multidetector-Row Computed Tomography to Echocardiography and Fluoroscopy for Evaluation of Patients With Mechanical Prosthetic Valve Obstruction",
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. {\circledC} 2009 Elsevier Inc. All rights reserved.",
author = "P. Symersky and R.P.J. Budde and {Mol, de}, B.A.J.M. and M. Prokop",
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Comparison of Multidetector-Row Computed Tomography to Echocardiography and Fluoroscopy for Evaluation of Patients With Mechanical Prosthetic Valve Obstruction. / Symersky, P.; Budde, R.P.J.; Mol, de, B.A.J.M.; Prokop, M.

In: American Journal of Cardiology, Vol. 104, No. 8, 2009, p. 1128-1134.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Comparison of Multidetector-Row Computed Tomography to Echocardiography and Fluoroscopy for Evaluation of Patients With Mechanical Prosthetic Valve Obstruction

AU - Symersky, P.

AU - Budde, R.P.J.

AU - Mol, de, B.A.J.M.

AU - Prokop, M.

PY - 2009

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N2 - 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. © 2009 Elsevier Inc. All rights reserved.

AB - 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. © 2009 Elsevier Inc. All rights reserved.

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VL - 104

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JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

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