Tina Leetmaa1, Nicolaj C Hansson2, Jonathon Leipsic1, Kaare Jensen1, Steen H Poulsen1, Henning R Andersen1, Jesper M Jensen1, John Webb1, Philipp Blanke1, Mariann Tang1, Bjarne L Nørgaard1. 1. From the Department of Cardiology (T.L., N.C.H., K.J., S.H.P., H.R.A., J.M.J., B.L.N.), Department of Cardiothoracic and Vascular Surgery (M.T.), Aarhus University Hospital Skejby, Aarhus, Denmark; and Division of Cardiology and Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (J.L., J.W., P.B.). 2. From the Department of Cardiology (T.L., N.C.H., K.J., S.H.P., H.R.A., J.M.J., B.L.N.), Department of Cardiothoracic and Vascular Surgery (M.T.), Aarhus University Hospital Skejby, Aarhus, Denmark; and Division of Cardiology and Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (J.L., J.W., P.B.). nh@dadlnet.dk.
Abstract
BACKGROUND: Early stent valve thrombosis after transcatheter aortic valve implantation (TAVI) is a rare complication, which is diagnosed based on the appearance of clinical symptoms of heart failure and echocardiographic findings. After TAVI, transthoracic echocardiography is performed to assess transcatheter heart valve (THV) function. However, preliminary reports indicate the potential additive clinical value of multidetector computed tomography (MDCT) for the diagnosis of THV thrombosis. We sought to determine the value of MDCT for the diagnosis of THV thrombosis and the frequency of this complication after balloon-expandable TAVI. METHODS AND RESULTS: MDCT was performed in 140 patients within 1 to 3 months after TAVI with the Edwards Sapien XT THV to assess the presence of THV thrombosis and THV stent geometry. Post-TAVI MDCT identified THV thrombosis in 5 patients (4%). Of note, 4 of these patients were asymptomatic and had a normal transthoracic echocardiographic examination without signs of thrombus formation or flow obstruction. In patients with THV thrombosis, a left ventricular ejection fraction of <35% was present in 3 (60%), whereas 2 (40%) did not receive standard post-TAVI dual-antiplatelet therapy. Neither THV underexpansion nor THV noncircularity was detected in patients with THV thrombosis. CONCLUSIONS: Post-TAVI MDCT is a valuable tool for the diagnosis of THV thrombosis, and this complication seems to be more common than previously anticipated. Larger studies are required to identify specific risk factors of THV thrombosis.
BACKGROUND: Early stent valve thrombosis after transcatheter aortic valve implantation (TAVI) is a rare complication, which is diagnosed based on the appearance of clinical symptoms of heart failure and echocardiographic findings. After TAVI, transthoracic echocardiography is performed to assess transcatheter heart valve (THV) function. However, preliminary reports indicate the potential additive clinical value of multidetector computed tomography (MDCT) for the diagnosis of THV thrombosis. We sought to determine the value of MDCT for the diagnosis of THV thrombosis and the frequency of this complication after balloon-expandable TAVI. METHODS AND RESULTS: MDCT was performed in 140 patients within 1 to 3 months after TAVI with the Edwards Sapien XT THV to assess the presence of THV thrombosis and THV stent geometry. Post-TAVI MDCT identified THV thrombosis in 5 patients (4%). Of note, 4 of these patients were asymptomatic and had a normal transthoracic echocardiographic examination without signs of thrombus formation or flow obstruction. In patients with THV thrombosis, a left ventricular ejection fraction of <35% was present in 3 (60%), whereas 2 (40%) did not receive standard post-TAVI dual-antiplatelet therapy. Neither THV underexpansion nor THV noncircularity was detected in patients with THV thrombosis. CONCLUSIONS: Post-TAVI MDCT is a valuable tool for the diagnosis of THV thrombosis, and this complication seems to be more common than previously anticipated. Larger studies are required to identify specific risk factors of THV thrombosis.
Authors: Hoda Hatoum; Jennifer Dollery; Scott M Lilly; Juan A Crestanello; Lakshmi Prasad Dasi Journal: Ann Thorac Surg Date: 2018-05-26 Impact factor: 4.330
Authors: Zhenglun Alan Wei; Simon Johannes Sonntag; Milan Toma; Shelly Singh-Gryzbon; Wei Sun Journal: Cardiovasc Eng Technol Date: 2018-04-19 Impact factor: 2.495
Authors: Manuel Hein; Jan Minners; Nikolaus Jander; Philipp Breitbart; Christian Stratz; Gregor Pache; Franz-Josef Neumann; Philipp Ruile Journal: Clin Res Cardiol Date: 2019-02-06 Impact factor: 5.460