Optimising cinefluoroscopy for accurate evaluation of mechanical prosthetic valves

BACKGROUND: Accurate assessment of mechanical prosthetic heart valves (PHVs) is essential to ensure proper function and long-term durability. Cinefluoroscopy (CF) enables real-time visualisation of valve leaflet motion but relies heavily on optimal projection angles for diagnostic accuracy. This study aimed to optimise CF imaging parameters to improve the reliability and precision of PHV evaluation. METHODS: Between October 2021 and June 2024, 262 patients with mechanical aortic or mitral PHVs underwent CF evaluation based on clinical or echocardiographic indications. Valve motion was evaluated across multiple patient positions (supine, right and left lateral decubitus) and C-arm projections. Imaging was considered optimal when the X-ray beam was perpendicular to the valve plane, allowing accurate visualisation of leaflet motion. If optimal imaging could not be achieved across all standard views, it was classified as non-optimal. RESULTS: A total of 331 mechanical PHVs were evaluated, including 250 aortic and 81 mitral prostheses. Optimal imaging was achieved in 94.8% of aortic and 66.7% of mitral valves. The supine position yielded the best visualisation in both groups (87.8% for aortic, 61.1% for mitral). The most frequent optimal projection was left anterior oblique-cranial for aortic valves and right anterior oblique-cranial for mitral valves. CONCLUSIONS: This study demonstrates that CF is an effective imaging modality for mechanical PHVs when appropriate positioning and projection angles are used. Optimal imaging is more readily achieved in aortic valves, while mitral valves require a more tailored approach due to anatomical constraints. Standardising imaging techniques may improve diagnostic accuracy and reduce radiation exposure in clinical practice.