Dominika Suchá1, Petr Symersky2, Renee B A van den Brink3, Wilco Tanis4, Eduard M Laufer5, Matthijs F L Meijs6, Jesse Habets7, Bas A J M de Mol8, Willem P Th M Mali7, Steven A J Chamuleau5, Lex A van Herwerden9, Ricardo P J Budde10. 1. Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: d.sucha@umcutrecht.nl. 2. Department of Cardiothoracic Surgery, VU Medical Center, PO Box 7057, 1081 HV Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. 3. Department of Cardiology, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. 4. Department of Cardiology, HagaZiekenhuis, PO Box 40551, 2504 LN Den Haag, The Netherlands. 5. Department of Cardiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. 6. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands. 7. Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. 8. Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. 9. Department of Cardiothoracic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. 10. Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Abstract
BACKGROUND: In patients with suspected prosthetic heart valve (PHV) dysfunction, routine evaluation echocardiography and fluoroscopy may provide unsatisfactory results for identifying the cause of dysfunction. This study assessed the value of MDCT as a routine, complementary imaging modality in suspected PHV-dysfunction for diagnosing the cause of PHV dysfunction and proposing a treatment strategy. METHODS: Patients with suspected PHV dysfunction were prospectively recruited. All patients underwent routine diagnostic work-up (TTE, TEE ± fluoroscopy) and additional MDCT imaging. An expert panel reviewed all cases and assessed the diagnosis and treatment strategy, first based on routine evaluation only, second with additional MDCT information. RESULTS: Forty-two patients were included with suspected PHV obstruction (n = 30) and PHV regurgitation (n = 12). The addition of MDCT showed incremental value to routine evaluation in 26/30 (87%) cases for detecting the specific cause of PHV obstruction and in 7/12 (58%) regurgitation cases for assessment of complications and surgical planning. The addition of MDCT resulted in treatment strategy change in 8/30 (27%) patients with suspected obstruction and 3/12 (25%) patients with regurgitation. CONCLUSION: In addition to echocardiography and fluoroscopy, MDCT may identify the cause of PHV dysfunction and alter the treatment strategy.
BACKGROUND: In patients with suspected prosthetic heart valve (PHV) dysfunction, routine evaluation echocardiography and fluoroscopy may provide unsatisfactory results for identifying the cause of dysfunction. This study assessed the value of MDCT as a routine, complementary imaging modality in suspected PHV-dysfunction for diagnosing the cause of PHV dysfunction and proposing a treatment strategy. METHODS:Patients with suspected PHV dysfunction were prospectively recruited. All patients underwent routine diagnostic work-up (TTE, TEE ± fluoroscopy) and additional MDCT imaging. An expert panel reviewed all cases and assessed the diagnosis and treatment strategy, first based on routine evaluation only, second with additional MDCT information. RESULTS: Forty-two patients were included with suspected PHV obstruction (n = 30) and PHV regurgitation (n = 12). The addition of MDCT showed incremental value to routine evaluation in 26/30 (87%) cases for detecting the specific cause of PHV obstruction and in 7/12 (58%) regurgitation cases for assessment of complications and surgical planning. The addition of MDCT resulted in treatment strategy change in 8/30 (27%) patients with suspected obstruction and 3/12 (25%) patients with regurgitation. CONCLUSION: In addition to echocardiography and fluoroscopy, MDCT may identify the cause of PHV dysfunction and alter the treatment strategy.
Authors: Marguerite E Faure; Laurens E Swart; Marcel L Dijkshoorn; Jos A Bekkers; Marcel van Straten; Koen Nieman; Paul M Parizel; Gabriel P Krestin; Ricardo P J Budde Journal: Eur Radiol Date: 2017-12-12 Impact factor: 5.315