The role of cardiac computed tomography in patients with prosthetic heart valves: Highlights from an Expert Consensus Document on Prosthetic Heart Valve Assessment

Valvular heart disease (VHD) is a population-based health problem, accounting for approximately 0.80% of all-cause mortality and 2.38% of total cardiovascular mortality worldwide (1) .The prevalence of VHD continues to increase, particularly among older adults, and is associated with reduced quality of life.Globally, the prevalence of rheumatic and non-rheumatic valvular heart disease has been estimated at 54.8 million and 13.3 million cases, respectively (2).Non-rheumatic aortic stenosis and degenerative mitral valve disease (mitral regurgitation) are the leading causes of VHD.Prosthetic heart valve (PHV) implantation is an effective treatment option for patients with VHD.Both transcatheter (bioprosthetic) and surgical (mechanical or bioprosthetic) valve replacement significantly reduce VHD-related morbidity and mortality.Nevertheless, PHVs introduce their own set of challenges and may be regarded as "replacing one disease with another acceptable disease."In addition to lifelong medical management, including anticoagulant therapy and its associated risk of hemorrhage, PHVs require close surveillance for valve dysfunction.Prosthetic valve dysfunction can be broadly classified into four categories: non-structural dysfunction (e.g., paravalvular leak and prosthesispatient mismatch), structural valve deterioration (e.g., fibrosis, calcification, leaflet prolapse, flail, tear, or strut/stent fracture), prosthetic valve thrombosis, and prosthetic valve endocarditis (3).Echocardiography remains the cornerstone of prosthetic valve evaluation.In the 2024 Guidelines for the Evaluation of Prosthetic Valve Function with Cardiovascular Imaging by Zoghbi and colleagues (4), echocardiography-based diagnostic criteria constitute the majority of the recommendations, whereas cardiac computed tomography (CT) and cardiac magnetic resonance imaging occupy relatively smaller sections.More recently, Budde et al. (5) published an expert consensus document on the use of cardiac CT for PHV assessment.In this editorial, we highlight the key recommendations and clinically relevant aspects of this expert consensus document.