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Ebrahimi P, Sattartabar B, Taheri H, Soltani P, Bahiraie P, Mousavinezhad SM, Gooshvar M, Kampaktsis PN, Arsanjani R, Sahebjam M, Hosseini K, Siegel RJ. Mechanical prosthetic valve thrombosis: A literature review of treatment strategies. Curr Probl Cardiol 2024; 49:102628. [PMID: 38729276 DOI: 10.1016/j.cpcardiol.2024.102628] [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: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Mechanical prosthetic valve thrombosis (MPVT) is a common complication of valvular implantations. This study compared the efficacy and safety of different treatments for MPVT. A systematic search of electronic databases identified studies evaluating surgical, anticoagulant, and thrombolytic therapies. Although several studies of different types have been conducted to evaluate the efficacy of these treatment strategies the lack of randomized controlled trials has resulted in the inability to make a definitive conclusion about the pros and cons of these treatments. Recent treatments, such as slow and ultraslow infusion of thrombolytics, showed comparable efficacy and lower complication rates than traditional methods. Inadequate anticoagulant use is a major risk factor for MPVT, highlighting the importance of prevention. Treatment selection should be individualized based on patient factors and available expertise. Overall, slow and ultraslow infusion of thrombolytics may be a promising treatment option for MPVT.
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Affiliation(s)
- Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Sattartabar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Taheri
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Parnian Soltani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Bahiraie
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehrdad Gooshvar
- School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Mohammad Sahebjam
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Soria Jiménez CE, Papolos AI, Kenigsberg BB, Ben-Dor I, Satler LF, Waksman R, Cohen JE, Rogers T. Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:2115-2127. [PMID: 37225366 DOI: 10.1016/j.jacc.2023.03.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023]
Abstract
Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation.
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Affiliation(s)
- César E Soria Jiménez
- Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA
| | - Alexander I Papolos
- Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Benjamin B Kenigsberg
- Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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3
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Prosthetic valve thrombosis: literature review and two case reports. COR ET VASA 2023. [DOI: 10.33678/cor.2022.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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4
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Derda AA, Marquardt MM, Martens A, Mirena E, Vogel-Claussen J, Kempf T, Haverich A, Bauersachs J, Napp LC. Cinefluoroscopy for assessment of mechanical heart valves with suspected dysfunction. Front Cardiovasc Med 2022; 9:952255. [PMID: 36148066 PMCID: PMC9486207 DOI: 10.3389/fcvm.2022.952255] [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] [Received: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mechanical heart valves (MHVs) are preferred prosthesis types in many, especially younger patients who need surgical valve replacement. Although echocardiography is most frequently performed for prosthesis assessment during follow-up, ultrasound artifacts usually preclude a precise investigation of prosthesis function. Cinefluoroscopy (CF) is a simple and effective method to analyze and quantify opening and closing of prosthesis leaflets but requires careful visualization of the valve using optimal viewing angles. Here, we investigated the quality of CF studies in clinical routine and their suitability for quantitative analysis of prosthesis function. Methods and results We retrospectively identified 94 patients with 118 cinefluoroscopies performed by 31 different investigators in one tertiary center from 2012 to 2021. Of 150 MHVs (98% bi-leaflet prostheses), 87 (58%) were aortic, 53 (34%) mitral, 7 (5%) tricuspid, and 5 (3%) pulmonary valve prostheses, respectively. CF studies were categorized by their suitability to quantitatively assess opening and closing angles. Visualization of valve function was “sufficient” in 23%, “suboptimal” in 46%, and “unsuitable” in 31% of the cases. Conclusion In clinical routine, only one-fourth of CF studies allow for a complete assessment of leaflet motion of MHVs. Although this may be in part due to the varying experience of operators, the high number of unsuitable studies suggests that optimal viewing angles may not be achievable in all patients. Further research is required to investigate standard viewing angles and anatomy after MHV implantation to improve the quality of CF studies and reduce radiation exposure of patients and operators.
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Affiliation(s)
- Anselm A. Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Marvin M. Marquardt
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elion Mirena
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- *Correspondence: L. Christian Napp,
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Darwish A, Di Labbio G, Saleh W, Smadi O, Kadem L. Experimental investigation of the flow downstream of a dysfunctional bileaflet mechanical aortic valve. Artif Organs 2019; 43:E249-E263. [DOI: 10.1111/aor.13483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Ahmed Darwish
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Giuseppe Di Labbio
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Wael Saleh
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Othman Smadi
- Department of Biomedical Engineering Hashemite University Zarqa Jordan
| | - Lyes Kadem
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
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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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8
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Park JE, Han K, Sung YS, Chung MS, Koo HJ, Yoon HM, Choi YJ, Lee SS, Kim KW, Shin Y, An S, Cho HM, Park SH. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal. Korean J Radiol 2017; 18:888-897. [PMID: 29089821 PMCID: PMC5639154 DOI: 10.3348/kjr.2017.18.6.888] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. Materials and Methods Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. Results Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. Conclusion Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Youngbin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Suah An
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyo-Min Cho
- Korea Research Institute of Standards and Science, Daejeon 34113, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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An investigation on the effects of the angles between the mitral and aortic orifice during diastolic period using FSI. PATHOPHYSIOLOGY 2017; 24:133-153. [DOI: 10.1016/j.pathophys.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022] Open
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Kim JH, Kim EY, Jin GY, Choi JB. A Review of the Use of Cardiac Computed Tomography for Evaluating the Mitral Valve before and after Mitral Valve Repair. Korean J Radiol 2017; 18:773-785. [PMID: 28860895 PMCID: PMC5552461 DOI: 10.3348/kjr.2017.18.5.773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/16/2017] [Indexed: 11/15/2022] Open
Abstract
The role of cardiac computed tomography (CT) for evaluating the mitral valve (MV) has been limited since echocardiography is the main method of evaluation. However, recent advances in cardiac CT have enable detailed evaluation of the anatomy and geometry of the MV. We describe assessments of the anatomy and coaptation geometric parameters of normal MVs, and also review repair of diseased/damaged MV. We also discuss pre- and post-surgical imaging of MV pathology using cardiac CT and various CT images. We found that cardiac CT could be used as an alternative imaging modality to echocardiography for pre-operative MV evaluation and to predict clinical outcomes following repair.
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Affiliation(s)
- Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Eun Young Kim
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences of Chonbuk National University Medical School, Jeonju 54907, Korea.,Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences of Chonbuk National University Medical School, Jeonju 54907, Korea
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
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Nabi F, Chebrolu LH, Chamsi-Pasha MA. A 70-Year-Old Woman with Acute Dyspnea and Mechanical Aortic Valve. Methodist Debakey Cardiovasc J 2017; 13:e1. [PMID: 30863485 PMCID: PMC6358168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Indexed: 06/09/2023] Open
Affiliation(s)
- Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Lakshmi H Chebrolu
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Mohammed A Chamsi-Pasha
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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12
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Absolute-Delay Multiphase Reconstruction Reduces Prosthetic Valve–Related and Atrial Fibrillation–Related Artifacts at Cardiac CT. AJR Am J Roentgenol 2017; 208:W160-W167. [DOI: 10.2214/ajr.16.16839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Moss AJ, Dweck MR, Dreisbach JG, Williams MC, Mak SM, Cartlidge T, Nicol ED, Morgan-Hughes GJ. Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction. Open Heart 2016; 3:e000494. [PMID: 27843568 PMCID: PMC5093391 DOI: 10.1136/openhrt-2016-000494] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/14/2016] [Indexed: 01/04/2023] Open
Abstract
Aortic valve replacement is the second most common cardiothoracic procedure in the UK. With an ageing population, there are an increasing number of patients with prosthetic valves that require follow-up. Imaging of prosthetic valves is challenging with conventional echocardiographic techniques making early detection of valve dysfunction or complications difficult. CT has recently emerged as a complementary approach offering excellent spatial resolution and the ability to identify a range of aortic valve replacement complications including structural valve dysfunction, thrombus development, pannus formation and prosthetic valve infective endocarditis. This review discusses each and how CT might be incorporated into a multimodal cardiovascular imaging pathway for the assessment of aortic valve replacements and in guiding clinical management.
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Affiliation(s)
- Alastair J Moss
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - John G Dreisbach
- Department of Radiology , Glasgow Royal Infirmary , Glasgow , UK
| | | | - Sze Mun Mak
- Department of Radiology , Imperial College Healthcare NHS Trust , London , UK
| | - Timothy Cartlidge
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Edward D Nicol
- Department of Cardiology , Royal Brompton Hospital and Harefield NHS Trust , London , UK
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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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15
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Song I, Park JA, Choi BH, Ko SM, Shin JK, Chee HK, Kim JS. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography. Korean J Radiol 2016; 17:463-71. [PMID: 27390538 PMCID: PMC4936169 DOI: 10.3348/kjr.2016.17.4.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/12/2016] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
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Affiliation(s)
- Inyoung Song
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jung Ah Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Je Kyoun Shin
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hyun Keun Chee
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jun Seok Kim
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
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