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Valvular Heart Disease and Prostheses

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CT of the Heart

Part of the book series: Contemporary Medical Imaging ((CMI))

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Abstract

This chapter describes how to utilize cardiac computed tomography angiography (CTA) for the assessment of cardiac valves and prosthesis. The dedicated CTA examination technique and the spectrum of imaging features among the various valvular diseases are presented and illustrated. The integration of CTA into the clinical work-up of patients based on scientific evidence is discussed.

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References

  1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):2438–88.

    Article  Google Scholar 

  2. Feuchtner G, Göetti R, Plass A, Baumueller S, Stolzmann P, Scheffel H, Wieser M, Marincek B, Alkadhi H, Leschka S. Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note. Eur Radiol. 2010;20(9):2093–9.

    Article  Google Scholar 

  3. Vrachliotis TG, Bis KG, Haidary A, Kosuri R, Balasubramaniam M, Gallagher M, Raff G, Ross M, O'neil B, O'neill W. Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography. Radiology. 2007;243(2):368–76.

    Article  Google Scholar 

  4. Feuchtner GM, Dichtl W, Friedrich GJ, et al. Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol. 2006;47(7):1410–7.

    Article  Google Scholar 

  5. Shah RG, Novaro GM, Blandon RJ, Whiteman MS, Asher CR, Kirsch J. Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography. Int J Cardiovasc Imaging. 2009;25(6):601–9.

    Article  Google Scholar 

  6. Ropers D, Ropers U, Marwan M, Schepis T, Pflederer T, Wechsel M, Klinghammer L, Flachskampf FA, Daniel WG, Achenbach S. Comparison of dual-source computed tomography for the quantification of the aortic valve area in patients with aortic stenosis versus transthoracic echocardiography and invasive hemodynamic assessment. Am J Cardiol. 2009;104(11):1561–7.

    Article  Google Scholar 

  7. Li X, Tang L, Zhou L, Duan Y, Yanhui S, Yang R, Wu Y, Kong X. Aortic valves stenosis and regurgitation: assessment with dual source computed tomography. Int J Cardiovasc Imaging. 2009;25(6):591–600.

    Article  CAS  Google Scholar 

  8. Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343:611–61.

    Article  CAS  Google Scholar 

  9. Pibarot P, Clavel MA. Management of paradoxical low-flow, low-gradient aortic stenosis: need for an integrated approach, including assessment of symptoms, hypertension, and stenosis severity. J Am Coll Cardiol. 2015;65(1):67–71.

    Article  Google Scholar 

  10. Alkadhi H, Leschka S, Trindade PT, Feuchtner G, Stolzmann P, Plass A, Baumueller S. Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery. AJR Am J Roentgenol. 2010;195(4):900.

    Article  Google Scholar 

  11. Murphy DJ, McEvoy SH, Iyengar S, Feuchtner G, Cury RC, Roobottom C, Baumueller S, Alkadhi H, Dodd JD. Bicuspid aortic valves: diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT. Eur J Radiol. 2014;83(8):1396–401.

    Article  Google Scholar 

  12. Gouveia S, Martins JD, Costa G, Paramés F, Freitas I, Rebelo M, Trigo C, F Pinto F. Quadricuspid aortic valve - 10-year case series and literature review. Rev Port Cardiol. 2011;30(11):849–54.

    Article  Google Scholar 

  13. Alkadhi H, Desbiolles L, Husmann L, Plass A, Leschka S, Scheffel H, Vachenauer R, Schepis T, Gaemperli O, Flohr TG, Genoni M, Marincek B, Jenni R, Kaufmann PA, Frauenfelder T. Aortic regurgitation: assessment with 64-section CT. Radiology. 2007;245(1):111–21.

    Article  Google Scholar 

  14. Feuchtner GM, Dichtl W, Müller S, et al. 64-MDCT for diagnosis of aortic regurgitation in patients referred to CT coronary angiography. Am J Roentgenol. 2008;191:W1–7.

    Article  Google Scholar 

  15. Feuchtner GM, Spoeck A, Lessick J, Dichtl W, Plass A, Leschka S, Mueller S, Klauser A, Scheffel H, Wolf F, Jaschke W, Alkadhi H. Quantification of aortic regurgitant fraction and volume with multi-detector computed tomography comparison with echocardiography. Acad Radiol. 2011;18(3):334–42.

    Article  Google Scholar 

  16. Messika-Zeitoun D, Serfaty JM, Laissy JP, et al. Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography. J Am Coll Cardiol. 2006;48:411–3.

    Article  Google Scholar 

  17. Alkadhi H, Wildermuth S, Bettex DA. Mitral regurgitation: quantification with 16-detector row CT—initial experience. Radiology. 2006;238:454–63.

    Article  Google Scholar 

  18. Delgado V, Tops L, Schujif JD, De Roos A, Brugada J, Schalij MJ, Thomas JD, Bax JJ. Assessment of mitral valve anatomy and geometry with multislice computed tomography. J Am Coll Cardiol Img. 2009;2(5):556–65.

    Article  Google Scholar 

  19. Feuchtner G, Alkadhi H, Karlo C, et al. Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography. Radiology. 2010;254:374–83.

    Article  Google Scholar 

  20. Srivatsa SS, Taylor MD, Hor K, Collins DA, King-Strunk M, Pelberg RA, Mazur W. Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization. Int J Cardiovasc Imaging. 2012;28(5):1161–71. https://doi.org/10.1007/s10554-011-9935-x. Epub 24 Aug 2011.

    Article  PubMed  Google Scholar 

  21. Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53(5):436–44.

    Article  Google Scholar 

  22. S M, Hangler H, Feuchtner G, Bartel T. Multimodality imaging reveals regurgitant jet lesion in aneurysmal anterior mitral leaflet: a severe complication of endocarditis. Eur Heart J. 2014;35(10):623.

    Article  Google Scholar 

  23. Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, Fowler VG Jr, Gordon D, Grossi P, Hannan M, Hoen B, Muñoz P, Rizk H, Kanj SS, Selton-Suty C, Sexton DJ, Spelman D, Ravasio V, Tripodi MF, Wang A, International Collaboration on Endocarditis–Prospective Cohort Study Investigators. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med. 2013;173(16):1495–504.

    Article  Google Scholar 

  24. Egbe AC, Pislaru SV, Pellikka PA, et al. Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors. J Am Coll Cardiol. 2015;66(21):2285–94.

    Article  Google Scholar 

  25. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015;373(21):2015–24.

    Article  CAS  Google Scholar 

  26. Bettencourt N, Rocha J, Carvalho M, Leite D, Toschke AM, Melica B, Santos L, Rodrigues A, Gonçalves M, Braga P, Teixeira M, Simões L, Rajagopalan S, Gama V. Multislice computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease. Circ Cardiovasc Imaging. 2009;2(4):306–13.

    Article  Google Scholar 

  27. Tsai IC, Lin YK, Chang Y, Fu YC, Wang CC, Hsieh SR, Wei HJ, Tsai HW, Jan SL, Wang KY, Chen MC, Chen CC. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol. 2009;19(4):857–67.

    Article  Google Scholar 

  28. Symersky P, Budde RP, de Mol BA, Prokop M. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol. 2009;104(8):1128–34.

    Article  Google Scholar 

  29. Fagman E, Perrotta S, Bech-Hanssen O, Flinck A, Lamm C, Olaison L, Svensson G. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur Radiol. 2012;22(11):2407–14.

    Article  Google Scholar 

  30. Habets J, Tanis W, Reitsma JB, van den Brink RB, Mali WP, Chamuleau SA, Budde RP. Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis. Eur Radiol. 2015;25(7):2125–33.

    Article  Google Scholar 

  31. Feuchtner G, Plank F, Mueller S, Schachner T, Bonaros N, Burghard P, Wolf F, Alhassan D, Blanke P, Leipsic J, Alkadhi H, Plass A, Spandorfer A, Felmly LM, De Cecco CN, Schoepf UJ. Cardiac computed tomography angiography for evaluation of prosthetic valve dysfunction. JACC Cardoivasc Imaging. 2017;10(1):91–3.

    Article  Google Scholar 

  32. Gündüz S, Özkan M, Kalçik M, Gürsoy OM, Astarcioğlu MA, Karakoyun S, Aykan AÇ, Biteker M, Gökdeniz T, Kaya H, Yesin M, Duran NE, Sevinç D, Güneysu T. Sixty-four-section cardiac computed tomography in mechanical prosthetic heart valve dysfunction: thrombus or pannus. Circ Cardiovasc Imaging. 2015;8(12):e003246.

    Article  Google Scholar 

  33. Tanis W, Habets J, van den Brink RB, Symersky P, Budde RP, Chamuleau SA. 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. 2014;15(2):119–29.

    Article  Google Scholar 

  34. Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, Casalta JP, Gouriet F, Riberi A, Avierinos JF, Collart F, Mundler O, Raoult D, Thuny F. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular (18)F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 2013;61(23):2374–82.

    Article  Google Scholar 

  35. Chenot F, Montant P, Goffinet C, Pasquet A, Vancraeynest D, Coche E, Vanoverschelde JL, Gerber BL. Evaluation of anatomic valve opening and leaflet morphology in aortic valve bioprosthesis by using multidetector CT: comparison with transthoracic echocardiography. Radiology. 2010;255(2):377–85.

    Article  Google Scholar 

  36. Suchá D, Symersky P, Vonken EJ, Provoost E, Chamuleau SA, Budde RP. Multidetector-row computed tomography allows accurate measurement of mechanical prosthetic heart valve leaflet closing angles compared with fluoroscopy. J Comput Assist Tomogr. 2014;38(3):451–6.

    Article  Google Scholar 

  37. Symersky P, Habets J, Westers P, de Mol BA, Prokop M, Budde RP. Prospective ECG triggering reduces prosthetic heart valve-induced artefacts compared with retrospective ECG gating on 256-slice CT. Eur Radiol. 2012;22(6):1271–7.

    Article  Google Scholar 

  38. Suchá D, Willemink MJ, de Jong PA, Schilham AM, Leiner T, Symersky P, Budde RP. The impact of a new model-based iterative reconstruction algorithm on prosthetic heart valve related artifacts at reduced radiation dose MDCT. Int J Cardiovasc Imaging. 2014;30(4):785–93.

    Article  Google Scholar 

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Correspondence to Gudrun M. Feuchtner .

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Feuchtner, G.M. (2019). Valvular Heart Disease and Prostheses. In: Schoepf, U. (eds) CT of the Heart. Contemporary Medical Imaging. Humana, Totowa, NJ. https://doi.org/10.1007/978-1-60327-237-7_39

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  • DOI: https://doi.org/10.1007/978-1-60327-237-7_39

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  • Publisher Name: Humana, Totowa, NJ

  • Print ISBN: 978-1-60327-236-0

  • Online ISBN: 978-1-60327-237-7

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