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MSCT in the Evaluation of Prosthetic Heart Valves Dysfunction Nguyen Xuan Trinh, MD MEDIC... Prosthetic Heart Valve PHV MEDIC Jesse Habets.. Type of Prosthetic Heart Valves PHV Mech

MSCT in the Evaluation of Prosthetic

Heart Valves Dysfunction

Nguyen Xuan Trinh, MD

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 In 2003, approximately 290,000 patients worldwide underwent heart-valve replacement and received a

Prosthetic heart valve (PHV)

Prosthetic Heart Valve (PHV)

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( Jesse Habets Computed Tomography of Prosthetic Heart Valves 2012 )

Type of Prosthetic Heart Valves (PHV)

Mechanical PHV

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 PHV dysfunction is a rare, but potentially

 Structural valve dysfunction: degeneration, wear,

fracture, and disc escape

 Nonstructural dysfunction: pannus formation , paravalvular leak, inappropriate sizing or positioning of the PHV, residual leak

or obstruction after valve implantation

PHV Dysfunction

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Imaging techniques

 Have a key role in PHV assessment and the detection of PHV dysfunction: TTE, TEE, 3D-TEE and fluoroscopy

 Echocardiography and fluoroscopy are the imaging

techniques of choice and are routinely used in daily

practice

 These techniques sometimes fail to determine the

specific cause of PHV dysfunction

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( Jesse Habets Computed Tomography of Prosthetic Heart Valves 2012 )

 Over the past 2 years, MSCT also has shown potential for PHV assessment

 MSCT can be of additional value in diagnosing the specific cause of PHV dysfunction and provides valuable

complementary information for surgical planning in case of reoperation

 Cardiac MRI has limited value in the evaluation of

biological PHV dysfunction

Imaging techniques

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Evaluation of Native or Prosthetic Valves

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MSCT

 With Mechanical PHV, opening and closing angles can be

measured as accurately as with fluoroscopy

 Biological leaflet thickening or calcification and leaflet

restriction can also be detected

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Residual opening angle (normal limit ≤ 20 °)-MSCT

(Tsai et al AJR 2011; 196:353–360)

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 P romising technique to localize the anatomical

MSCT

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Disadvantages of MSCT

 Radiation exposure

 640 slice- MSCT: lower radiation doses

 Need for contrast injection

 Morbidity and mortality associated with PHV

dysfunction is high and MSCT can help to establish the exact cause of the dysfunction

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Pannus Imaging

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( Amal Ibrahim Khalifa, M.D Assessment of Prosthetic Valves Prosthetic Malfunction 3/18/2013)

PHV thrombus

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Suggested Non-invasive Imaging Protocol in the Diagnostic Suspected PHV dysfunction MEDIC

( Jesse Habets Computed Tomography of Prosthetic Heart Valves 2012 )

Biological PHV dysfunction

 Most notably, biological PHVs degenerate after a variable time

period (10–20 years)

biological PHV dysfunction, but both techniques can fail to identify the exact cause of the PHV obstruction

by identifying pannus tissue or subvalvular obstruction

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Case 1

 45F, Mechanical AVR and MVR (2009),

 MV Prosthesis were stuck ( 2 times)

 Mechanical AVR and Bio-Prosthetic MV (2009)

 Anticoagulation had been discontinued

 Upon admission: increased Grd peak/ mean across the

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Residual Opening Angle

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MSCT Imaging of Mechanical Aortic Valve-

posterior leaflet restriction

Pannus Imaging

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MOVIE 1

Case 2

 62M, Bio-Prosthetic AVR (2011)

 Irregular check up

 Upon admission: increased Grd peak / mean across the

Subvalvular mass ?)

leaflet restriction, biological PHVs degenerate ) and severe

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Biological PHV Thickening and Degenerate

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Biological PHV Thickening and Degenerate- leaflet restriction

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Biological PHV Thickening, Degenerate and Severe

Paravalvular Calcification

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MOVIE 2

CONCLUSIONS

identification of the exact cause of PHV obstruction (thrombus vs pannus) is difficul

 MSCT:

 Additional diagnostic value in the evaluation of PHV dysfunction

 More complete assessment of the cause of PHV dysfunction and the surrounding anatomy

 Key role in preoperative surgical planning and exclusion of CAD

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Thank you for your attention