Impact of cardiac computed tomographic angiographyon diagnostic and therapeutic decisions in patientswith suspected prosthetic heart valve dysfunction

Fig. 1. Diagram for enrolled patients.

Fig. 2. CT and TEE findings in a patient with suspected prosthetic valve malfunction (A): TEE, mid esophageal, two chamber view, the posteromedial occluder (blue arrow) showed malfunction in opening position as compared to anterior one (red arrow) with unknown underlying cause. (B) MCTA, axial cut, four chamber view showing absent excursion of medial mitral occluder (blue arrow) as compared to lateral one. (C): MCTA, coronal cut, two chamber view showing small hypoechogenic thrombus attached to atrial aspect of mitral occluder that is not apparent by TEE (red arrow). (D): Surgical image for mitral prosthesis occluder thrombus (red arrow).

Fig. 3. CT detects aortic root pseudo aneurysms and relation to surrounding structures (small pseudo aneurysm was missed by TEE) (A): TEE, Mid esophageal short axis view showing large aortic root pseudoaneurysm (White arrow) with ill-defined borders and relations by TEE and multiple small mobile masses (Blue arrow) mostly vegetation. Red arrow refers to aortic mechanical prosthesis. (B): TEE, Mid esophageal short axis view showing large aortic root pseudoaneurysm measuring 3.76 × 3.49 cm. (C): MCTA, Sagittal cut, long axis view showing huge aortic root pseudoaneurysm measures 5.5 × 5.4 cm in its largest dimensions related to the posterior aspect of the aorta and communicate with left ventricle outflow tract with large neck (blue arrow). (D): MCTA, sagittal cut, showing another smaller aortic root pseudoaneurysm (red arrow) related anterior wall of the ascending aorta at the ostium of the right coronary artery. (E): MCTA, axial cut, showing huge aortic root pseudoaneurysm (blue arrow) and its relation to surrounding cardiac structures, compresses left atrium (White arrow). (F): shows indentation of right pulmonary artery (red arrow) by huge aortic root pseudoaneurysm.

Fig. 4. CT and TEE in a patient with suspected paravalvular leak and heart failure symptoms (A, B): TEE, mid esophageal, long axis view, showing paravalvular regurgitation related to posterior aspect of aortic mechanical prosthesis with jet width measuring 1 cm and occupies 50% of LVOT. (C): MCTA, coronal cut, long axis view showing aortic prosthetic PVL with severe calcifications (red arrow) related to PVL defect cause of defect not apparent by TEE. (D) is a surgical image showing aortic prosthesis PVL defect for the same patient (blue arrow).