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Added value of cardiac computed tomography for evaluation of mechanical aortic valve: Emphasis on evaluation of pannus with surgical findings as standard reference.

 Young Joo Suh  ;  Sak Lee  ;  Dong Jin Im  ;  Suyon Chang  ;  Yoo Jin Hong  ;  Hye-Jeong Lee  ;  Jin Hur  ;  Byoung Wook Choi  ;  Byung-Chul Chang  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Young Jin Kim 
 International Journal of Cardiology, Vol.214 : 454-460, 2016 
Journal Title
 International Journal of Cardiology 
Issue Date
Adult ; Aortic Valve/diagnostic imaging* ; Aortic Valve/surgery ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases/diagnostic imaging* ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis/adverse effects* ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Multimodal Imaging/methods* ; Reoperation ; Sensitivity and Specificity ; Tomography, X-Ray Computed
Aortic valve replacement ; Computed tomography ; Mechanical valve ; Pannus formation
BACKGROUND: The added value of cardiac computed tomography (CT) with transesophageal echocardiography (TEE) for evaluating mechanical aortic valve (AV) dysfunction has not yet been investigated. The purposes of this study were to investigate the added value of cardiac CT for evaluation of mechanical AVs and diagnoses of pannus compared to TEE, with surgical findings of redo-aortic valve replacement (AVR) used as a standard reference. METHODS: 25 patients who underwent redo-AVR due to mechanical AV dysfunction and cardiac CT before redo-AVR were included. The presence of pannus, encroachment ratio by pannus, and limitation of motion (LOM) were evaluated on CT. The diagnostic performance of pannus detection was compared using TEE, CT, and CT+TEE, with surgical findings as a standard reference. The added value of CT for diagnosing the cause of mechanical AV dysfunction was assessed compared to TTE+TEE. RESULTS: In two patients, CT analysis was not feasible due to severe metallic artifacts. On CT, pannus and LOM were found in 100% (23/23) and 60.9% (14/23). TEE identified pannus in 48.0% of patients (12/25). CT, TEE, and CT+TEE correctly identified pannus with sensitivity of 92.0%, 48.0%, and 92.0%, respectively (P=0.002 for CT vs. TEE). In 11 of 13 cases (84.6%) with inconclusive or negative TEE results for pannus, CT detected the pannus. Among 13 inconclusive cases of TTE+TEE for the cause of mechanical AV dysfunction, CT suggested 6 prosthetic valve obstruction (PVO) by pannus, 4 low-flow low-gradient PVO, and one LOM without significant PVO. CONCLUSIONS: Cardiac CT showed added diagnostic value with TEE in the detection of pannus as the cause of mechanical AV dysfunction.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
김영진(Kim, Young Jin) ORCID logo https://orcid.org/0000-0002-6235-6550
서영주(Suh, Young Joo) ORCID logo https://orcid.org/0000-0002-2078-5832
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
이삭(Lee, Sak) ORCID logo https://orcid.org/0000-0001-6130-2342
이혜정(Lee, Hye Jeong) ORCID logo https://orcid.org/0000-0003-4349-9174
임동진(Im, Dong Jin) ORCID logo https://orcid.org/0000-0001-8139-5646
장병철(Chang, Byung Chul)
장수연(Chang, Su Yon)
최병욱(Choi, Byoung Wook) ORCID logo https://orcid.org/0000-0002-8873-5444
허진(Hur, Jin) ORCID logo https://orcid.org/0000-0002-8651-6571
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
홍유진(Hong, Yoo Jin) ORCID logo https://orcid.org/0000-0002-7276-0944
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