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Kalcik M, Güner A, Gündüz S, Özkan M. Substantial Value of Cardiac Computed Tomography for the Evaluation of Patients with Suspected Prosthetic Valve Dysfunction. Cardiology 2020; 145:652-653. [PMID: 32898851 DOI: 10.1159/000509917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Macit Kalcik
- Department of Cardiology, Faculty of Medicine, Hitit University, Corum, Turkey,
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.,Division of Health Sciences, Ardahan University, Ardahan, Turkey
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Senapati A, Faza NN, Mahmarian J, Chang SM. Cardiac Computed Tomography for Structural Heart Disease Assessment and Therapeutic Planning: Focus on Prosthetic Valve Dysfunction. Methodist Debakey Cardiovasc J 2020; 16:86-96. [PMID: 32670468 DOI: 10.14797/mdcj-16-2-86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Of the 100,000-plus valve surgeries performed each year in the United States, up to 6% of those develop complications from prosthetic valve dysfunction. Prosthetic valve dysfunction (PVD) can be life threatening and often challenging to diagnose. In this review, we discuss the prevalence and incidence of PVD, explore its different etiologies, and assess the role of multimodality imaging with an emphasis on cardiac multidetector computed tomography (MDCT) for evaluating patients with PVD. We also investigate the utility of MDCT in preprocedural planning for transcatheter devices and redo surgical planning and discuss management strategies for patients with PVD.
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Affiliation(s)
- Alpana Senapati
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Nadeen N Faza
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Kim W, Choi H, Kweon J, Yang DH, Kim YH. Effects of pannus formation on the flow around a bileaflet mechanical heart valve. PLoS One 2020; 15:e0234341. [PMID: 32530931 PMCID: PMC7292405 DOI: 10.1371/journal.pone.0234341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022] Open
Abstract
Some patients with a bileaflet mechanical heart valve (BMHV) show significant increases in the transvalvular pressure drop and abnormal leaflet motion due to a pannus (an abnormal fibrovascular tissue) formed on the ventricular side, even in the absence of physical contact between the pannus and leaflets. We investigate the effects of the pannus shape (circular or semi-circular ring), implantation location and height on the leaflet motion, flow structure and transvalvular pressure drop using numerical simulations. The valve model considered resembles a 25 mm masters HP valve. The mean systolic pressure drop is significantly increased with increasing pannus height, irrespective of its implantation orientation. Near the peak inflow rate, the flow behind the pannus becomes highly turbulent, and the transvalvular pressure drop is markedly increased by the pannus. At the end of valve opening and the start of valve closing, oscillatory motions of the leaflets occur due to periodic shedding of vortex rings behind the pannus, and their amplitudes become large with increasing pannus height. When the pannus shape is asymmetric (e.g., a semi-circular ring) and its height reaches about 0.1D (D (= 25 mm) is the diameter of an aorta), abnormal leaflet motions occur: two leaflets move asymmetrically, and valve closing is delayed in time or incomplete, which increases the regurgitation volume. The peak energy loss coefficients due to panni are obtained from simulation data and compared with those predicted by a one-dimensional model. The comparison indicates that the one-dimensional model is applicable for the BMHV with and without pannus.
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Affiliation(s)
- Woojin Kim
- Department of Mechanical Engineering, Seoul National University, Seoul, Korea
| | - Haecheon Choi
- Department of Mechanical Engineering, Seoul National University, Seoul, Korea
- Institute of Advanced Machines and Design, Seoul National University, Seoul, Korea
- * E-mail:
| | - Jihoon Kweon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Nam K, Suh YJ, Han K, Park SJ, Kim YJ, Choi BW. Value of Computed Tomography Radiomic Features for Differentiation of Periprosthetic Mass in Patients With Suspected Prosthetic Valve Obstruction. Circ Cardiovasc Imaging 2019; 12:e009496. [DOI: 10.1161/circimaging.119.009496] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background:
We aimed to determine whether quantitative computed tomography radiomic features can aid in differentiating between the causes of prosthetic valve obstruction (PVO) in patients who had undergone prosthetic valve replacement.
Methods:
This retrospective study included 39 periprosthetic masses in 34 patients who underwent cardiac computed tomography scan from January 2014 to August 2017 and were clinically suspected as PVO. The cause of PVO was assessed by redo-surgery and follow-up imaging as standard reference, and classified as pannus, thrombus, or vegetation. Visual analysis was performed to assess the possible cause of PVO on axial and valve-dedicated views. Computed tomography radiomic analysis of periprosthetic masses was performed and radiomic features were extracted. The advantage of radiomic score compared with visual analysis for differentiation of pannus from other abnormalities was assessed.
Results:
Of 39 masses, there were 20 cases of pannus, 11 of thrombus, and 8 of vegetation on final diagnosis. The radiomic score was significantly higher in the pannus group compared with nonpannus group (mean, −0.156±0.422 versus −0.883±0.474;
P
<0.001). The area under the curve of radiomic score for diagnosis of pannus was 0.876 (95% CI, 0.731–0.960). Combination of radiomic score and visual analysis showed a better performance for the differentiation of pannus than visual analysis alone.
Conclusions:
Compared with visual analysis, computed tomography radiomic features may have added value for differentiating pannus from thrombus or vegetation in patients with suspected PVO.
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Affiliation(s)
- Kyungsun Nam
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Sang Joon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Korea (S.J.P.)
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
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Kim JY, Suh YJ, Han K, Kim YJ, Choi BW. Diagnostic Value of Advanced Imaging Modalities for the Detection and Differentiation of Prosthetic Valve Obstruction. JACC Cardiovasc Imaging 2019; 12:2182-2192. [DOI: 10.1016/j.jcmg.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 01/18/2023]
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Aladmawi MA, Pragliola C, Vriz O, Galzerano D. Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves. J Thorac Dis 2017; 9:S343-S348. [PMID: 28540078 DOI: 10.21037/jtd.2017.04.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obstruction of a mechanical aortic valve by pannus formation at the subvalvular level is a major long-term complication of aortic valve replacement (AVR). In fact, pannus is sometime difficult to differentiate from patient-prosthesis mismatch or valve thrombosis. In most cases cine-angiography and echocardiography, either transthoracic or transesophageal, cannot correctly visualize the complication when the leaflets show a normal mobility. Recent technological refinements made this difficult diagnosis possible by ECG-gated computed tomography (CT) scan which shows adequate images in 90% of the cases and can differentiate pannus from fresh and organized thrombus.
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Affiliation(s)
- Mohamed A Aladmawi
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Domenico Galzerano
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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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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Chaikriangkrai K, Maragiannis D, Belousova T, Little S, Nabi F, Mahmarian J, Chang SM. Clinical Utility of Multidetector Computed Tomography in Redo Valve Procedures. J Card Surg 2016; 31:139-46. [DOI: 10.1111/jocs.12694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Dimitrios Maragiannis
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
| | - Tatiana Belousova
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
| | - Stephen Little
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
| | - Faisal Nabi
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
| | - John Mahmarian
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
| | - Su Min Chang
- Methodist DeBakey Heart & Vascular Center; Houston Methodist Hospital; Houston Texas
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Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003246. [DOI: 10.1161/circimaging.115.003246] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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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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12
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CT of Cardiac Valves. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gürsoy MO, Kalçik M, Karakoyun S, Özkan M. The Current Status of Fluoroscopy and Echocardiography in the Diagnosis of Prosthetic Valve Thrombosis-A Review Article. Echocardiography 2014; 32:156-64. [DOI: 10.1111/echo.12721] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
| | - Macit Kalçik
- Department of Cardiology; Koşuyolu Kartal Heart Training and Research Hospital; Istanbul Turkey
| | | | - Mehmet Özkan
- Faculty of Medicine; Department of Cardiology; Kars Kafkas University; Kars Turkey
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