Jesse Habets MD, Presenter: Nothing to Disclose

Renee B.a. Van Den Brink MD,PhD, Abstract Co-Author: Nothing to Disclose

Ruben Uijlings MD, Abstract Co-Author: Nothing to Disclose

Anje Spijkerboer MD, PhD, Abstract Co-Author: Nothing to Disclose

Willem P. Mali MD, PhD, Abstract Co-Author: Nothing to Disclose

Steven Chamuleau MD, PhD, Abstract Co-Author: Nothing to Disclose

Ricardo P.J. Budde MD, PhD, Abstract Co-Author: Nothing to Disclose

Patients with a prosthetic heart valve (PHV) may require assessment for the presence of coronary artery disease. We evaluated whether PHV artifacts prohibit coronary artery assessment by multislice computed tomography (MSCT).

Seventy ECG-gated CTAs performed on a 64-slice (n=25) or 256-slice (n=45) scanner were retrospectively scored for the presence of PHV related artifacts prohibiting coronary artery assessment on the axial CT images by a single observer.

Mean heart rate was 73±17 bpm (range 48-138). We investigated 61 mechanical and 17 biological PHVs, positioned in the aortic (n=59), mitral (n=17), pulmonary (n=1) and tricuspid (n=1) position. In addition, seven annuloplasty rings were present. PHV artifacts prohibiting assessment of at least one coronary segment were present in 12/70 patients (17%). Artifacts were located in the RCA in 9/70 patients (13%) (mainly from PHVs in the aortic position), in the LCX in 7/70 patients (10%) and in the LAD in 3/70 patients (4%) (both mainly from PHVs in mitral position) and never in the left main coronary artery. Biological PHVs (0/17), annuloplasty rings (0/7), Carbomedics bileaflet (0/20), ON-X bileaflet (0/7) and Medtronic Hall tilting disc (1/11) PHVs caused no or virtually no artifacts precluding coronary artery assessment. However, coronary artery assessment was hampered by PHV-related artifacts in the bileaflet Saint Jude (3/11) and Duromedics (1/1) PHVs as well as Sorin (5/7) and Björk Shiley (4/4) tilting disc PHVs.

The suitability of MSCT for imaging of the coronary artery segments in patients with PHVs depends on prosthetic valve type (e.g. valve housing material) and position, rather than valve design (tilting disc versus bileaflet). Björk-Shiley and Sorin tilting disc PHVs almost always preclude coronary artery assessment, whereas ON-X and Carbomedics PHVs, biological PHVs and annuloplasty rings do not.

MSCT is a useful imaging technique to evaluate coronary artery disease in most patients after prosthetic heart valve replacement.

Habets, J, Van Den Brink, R, Uijlings, R, Spijkerboer, A, Mali, W, Chamuleau, S, Budde, R, Coronary Artery Assessment with Multislice Computed Tomography in Patients with a Prosthetic Heart Valve: Is Coronary Assessment Hampered by Valve-related Artifacts?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034409.html