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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.

Authors
 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 
Citation
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.214 : 454-460, 2016 
Journal Title
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN
 0167-5273 
Issue Date
2016
MeSH
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
Keywords
Aortic valve replacement ; Computed tomography ; Mechanical valve ; Pannus formation
Abstract
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0167527316306866
DOI
10.1016/j.ijcard.2016.04.011
Appears in Collections:
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
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Im, Dong Jin(임동진) ORCID logo https://orcid.org/0000-0001-8139-5646
Chang, Byung Chul(장병철)
Chang, Su Yon(장수연)
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
Hong, Yoo Jin(홍유진) ORCID logo https://orcid.org/0000-0002-7276-0944
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146837
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