Clinical value of computed tomography in suspected prosthetic valve dysfunction

Figures

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  Fig. 1. Normal leaflet motion on CT in a patient with elevated Doppler gradient across a mechanical mitral valve prosthesis. Images of a patient with a mechanical PHV (Carbomedics, size 25 mm) who presented with progressive exertional dyspnoea. TTE demonstrated an elevated mean transmitral gradient (11 mm Hg; Panel a), whereas transesophageal echocardiography and angiography were unremarkable. Cardiac CT showed normal disc motion without evidence of pannus or thrombus (Panels b–c). Dyspnea was attributed to COPD (GOLD II), and conservative management was initiated. At four-year follow-up, the echocardiographic gradient had normalised (3.3 mm Hg) with preserved biventricular function and a stable invasively measured transmitral gradient of 5 mm Hg

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  Fig. 2. Thrombotic obstruction of a mechanical aortic valve diagnosed by CT. Images in a patient with a mechanical aortic valve (Carbomedics, size 25 mm), who presented with recurrent cortical strokes during episodes of subtherapeutic INR, caused by thromboembolic cerebrovascular occlusion. Transthoracic and transesophageal (panel a) echocardiography were inconclusive due to acoustic shadowing from the mechanical PHV, precluding definitive assessment of disc motion. Cardiac CT suggested prosthetic valve thrombosis, showing asymmetric disc opening (67.3 and 79.1°; panel b) that indicated impaired right disc mobility, symmetric disc closure, and a hypodense mass (arrowhead in panel b) adjacent to the sewing ring

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  Fig. 3. Transthoracic echocardiography findings in patients with positive and negative CT findings regarding PVD. Echocardiography performed within 3 months of CT categorized valve function as normal, as suggestive of a stenosis, or as a significant stenosis. The distribution of these findings is displayed for the CT-positive and CT-negative patient groups, showing a significant between-group difference (p = 0.004)