Dominika Sucha MD, Presenter: Nothing to Disclose

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

Petr Symersky MD, Abstract Co-Author: Nothing to Disclose

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

Bas De Mol MD, PhD, Abstract Co-Author: Nothing to Disclose

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

Jesse Habets MD, Abstract Co-Author: Nothing to Disclose

Lex Van Herwerden, Abstract Co-Author: Research Consultant, St. Jude Medical, Inc

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

To present the first prospective trial in prosthetic heart valve (PHV) patients that has been performed short after PHV implantation to assess normal postoperative multidetector-row computed tomography (MDCT) reference images, image quality and detect unexpected pathology.

All patients were prospectively included and underwent contrast-enhanced 256-slice retrospectively ECG-gated MDCT approximately six weeks after uncomplicated PHV implantation. Overall image quality was scored by two observers in best systolic and diastolic phases (1=non-diagnostic, 2=moderate, 3=good, 4=excellent). Moreover, leaflet motion, surrounding anatomy and PHV-related abnormalities were evaluated. Echocardiography was performed at the same moment as MDCT imaging.

Forty-six patients (mean age 64±12 yrs) with 33 mechanical (12 Carbomedics, 12 St-Jude, 5 ON-X, 4 Sorin) and 16 biological (12 Perimount, 4 Mitroflow) PHVs were imaged (mean 47±10 days postimplant). Median (range) image quality for PHVs was 3.0 (2.0-4.0) Carbomedics; 3.0 (2.0-4.0) St-Jude; 3.0 (3.0-3.5) ON-X; 2.5 (2.5-3.0) Sorin; 3.0 (2.5-4.0) Perimount; 2.5 (2.0-2.5) Mitroflow. All mechanical PHVs showed symmetrical leaflet motion. Minor postoperative findings were present in 40 patients and included moderate pericardial effusion (3/46 patients), periaortic/pericardial hematoma (3/46 patients), slight PHV angulation (3/40 aortic PHVs) and fuzziness of the periaortic fat (33/40 aortic PHVs). Unexpected pathology was found with MDCT in three cases. One showed pseudoaneurysms with severe PHV dehiscence requiring reoperation. The other concerned aspecific subprosthetic tissue and a supraprosthetic pseudoaneurysm, both requiring follow-up. The latter also revealed an unexpected relevant coronary anomaly.

Post-implantation MDCT showed overall good image quality for biological and mechanical PHVs and symmetrical leaflet motion in all mechanical PHVs. Minor postoperative findings were present in most patients and MDCT detected three cases of unexpected clinically relevant pathology requiring reoperation or follow-up. These first postoperative MDCT reference characteristics allow discrimination of normal and pathological conditions.

Normal postoperative MDCT imaging characteristics and findings in patients with commonly implanted PHVs allow discrimination of normal and pathological conditions short after implantation and at follow-up

Sucha, D, Chamuleau, S, Symersky, P, Van Den Brink, R, De Mol, B, Mali, W, Habets, J, Van Herwerden, L, Budde, R, Multidetector-row CT Findings Six Weeks Post Prosthetic Heart Valve Implantation: Results of the IMPACT Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010296.html