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01-06-2015 | Cardiac

Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

Authors: Wilco Tanis, Dominika Suchá, Ward Laufer, Jesse Habets, Lex. A. van Herwerden, Petr Symersky, Steven Chamuleau, Ricardo P. J. Budde

Published in: European Radiology | Issue 6/2015

Abstract

Objectives

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG).

Methods

PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test.

Results

Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two.

Conclusion

MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD.

Key Points

• Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment

• In case of PHV reoperation, invasive coronary angiography is also required

• MDCT can replace CAG in 50 % of patients without coronary artery disease

• When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate

• Replacing CAG saves associated risks of distant embolization of thrombi or vegetations

Habets J, Tanis W, Mali WP, Chamuleau SA, Budde RP (2012) Imaging of prosthetic heart valve dysfunction: complementary diagnostic value of TEE and MDCT? JACC Cardiovasc Imaging 5:956–961CrossRefPubMed

Ueda T, Teshima H, Fukunaga S, Aoyagi S, Tanaka H (2013) Evaluation of prosthetic valve obstruction on electrocardiographically gated multidetector-row computed tomography–identification of subprosthetic pannus in the aortic position. Circ J 77:418–423CrossRefPubMed

Tanis W, Habets J, van den Brink RB, Symersky P, Budde RP, Chamuleau SA (2014) Differentiation of thrombus from pannus as the cause of acquired mechanical prosthetic heart valve obstruction by non-invasive imaging: a review of the literature. Eur Heart J Cardiovasc Imaging 15:119–129CrossRefPubMed

Habets J, Tanis W, van Herwerden LA, van den Brink RB, Mali WP, de Mol BA et al (2014) Cardiac computed tomography angiography results in diagnostic and therapeutic change in prosthetic heart valve endocarditis. Int J Cardiovasc Imaging 30:377–387CrossRefPubMed

Fagman E, Perrotta S, Bech-Hanssen O, Flinck A, Lamm C, Olaison L et al (2012) ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur Radiol 22:2407–2414CrossRefPubMed

Teshima H, Hayashida N, Fukunaga S, Tayama E, Kawara T, Aoyagi S et al (2004) Usefulness of a multidetector-row computed tomography scanner for detecting pannus formation. Ann Thorac Surg 77:523–526CrossRefPubMed

Feuchtner GM, Stolzmann P, Dichtl W, Schertler T, Bonatti J, Scheffel H et al (2009) Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol 53:436–444CrossRefPubMed

Tanis W, Habets J (2013) Images in clinical medicine. The silence of the leaflets. N Engl J Med 368:e21CrossRefPubMed

Habets J, Mali WP, Budde RP (2012) Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics 32:1893–1905CrossRefPubMed

10.

Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H et al (2012) Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496CrossRefPubMed

11.

Meijboom WB, Mollet NR, Van Mieghem CA, Kluin J, Weustink AC, Pugliese F et al (2006) Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery. J Am Coll Cardiol 48:1658–1665CrossRefPubMed

12.

Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144CrossRefPubMed

13.

Habets J, van den Brink RB, Uijlings R, Spijkerboer AM, Mali WP, Chamuleau SA et al (2012) Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves. Eur Radiol 22:1278–1286CrossRefPubMedCentralPubMed

14.

Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR (2009) Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J 157:132–140CrossRefPubMed

15.

Kolh P, Wijns W, Danchin N, Di Mario C, Falk V, Folliguet T (2010) Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneous Cardiovascular Interventions (EAPCI), guidelines on myocardial revascularization. Eur J Cardiothorac Surg 38:S1–S52CrossRefPubMed

16.

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van't Veer M et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed

17.

Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3:122–136CrossRefPubMed

18.

Weustink AC, Nieman K, Pugliese F, Mollet NR, Meijboom WB, van Mieghem C et al (2009) Diagnostic accuracy of computed tomography angiography in patients after bypass grafting: comparison with invasive coronary angiography. JACC Cardiovasc Imaging 2:816–824CrossRefPubMed

19.

Symersky P, Habets J, Westers P, de Mol BA, Prokop M, Budde RP (2012) Prospective ECG triggering reduces prosthetic heart valve-induced artefacts compared with retrospective ECG gating on 256-slice CT. Eur Radiol 22:1271–1277CrossRefPubMedCentralPubMed

Title: Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?
Authors: Wilco Tanis
Dominika Suchá
Ward Laufer
Jesse Habets
Lex. A. van Herwerden
Petr Symersky
Steven Chamuleau
Ricardo P. J. Budde
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3551-9

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Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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