European Heart Journal Advance Access originally published online on April 13, 2006
European Heart Journal 2006 27(21):2537; doi:10.1093/eurheartj/ehi873
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Usefulness of ECG-gated multi-detector computed tomography for the diagnosis of mechanical prosthetic valve dysfunction
The Cardiovascular Center, University of Picardie, Amiens, France
* Corresponding author. CHU Amiens Sud, Service de Réanimation Cardiaque, 80054 Amiens Cédex 01, France. Tel: +33 3 22 45 58 70; fax: +33 3 22 45 56 61; E-mail address: leborgne.laurent{at}chu-amiens.fr
A 70-year-old woman who had an aortic valve replacement with a bileaflet mechanical prosthetic aortic valve 14 months earlier, presented with congestive heart failure.
She was operated for intestinal carcinoma that resulted in an inadequate anticoagulation management. On presentation, the international normalized ratio was 1.9. Initial examination revealed a loud systolic aortic murmur and muffling of the valve click.
Echocardiography coupled with Doppler showed an increased valvular mean pressure gradient (Panel A) as compared with the previous values (45 vs. 18 mmHg) associated with a grade I aortic regurgitation. As the patient was haemodynamically unstable, a transoesophageal echocardiography could not be performed.
To clarify the mechanism of the valve dysfunction, a 16-slice spiral computed tomography (CT) with three-dimensional volume rendering reconstruction centered on the aortic prosthetic valve was performed (scan parameters: rotation time, 0.5 s; slice thickness, 0.625 mm; increment reconstruction, 0.5 mm; retrospective reconstruction of 20 phases of the R–R interval). On these views, one hemidisk was totally immobile and stayed open during diastole (white arrow) (Panel B: lateral view, Panel C: upper view).
The absence of significant aortic regurgitation implied that an obstructive thrombus was involved. As the patient had a moderate renal insufficiency, contrast material was not injected.
The patient had an aortic valve replacement with a bioprosthesis. The operative piece (Panel D) showed MIRA EDWARDS aortic valve with a voluminous thrombus blocking the hemidisk in the vertical position (white arrow).
ECG-gated multislice CT offers the benefit of rapid and very precise three-dimensional assessment of leaflets motion of mechanical prosthetic valves, especially in patients who have haemodynamic instability and who could not have transoesophageal echocardiography.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. M. LaBounty, P. P. Agarwal, A. Chughtai, D. S. Bach, E. Wizauer, and E. A. Kazerooni Evaluation of Mechanical Heart Valve Size and Function With ECG-Gated 64-MDCT Am. J. Roentgenol., November 1, 2009; 193(5): W389 - W396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Feuchtner, P. Stolzmann, W. Dichtl, T. Schertler, J. Bonatti, H. Scheffel, S. Mueller, A. Plass, L. Mueller, T. Bartel, et al. Multislice computed tomography in infective endocarditis comparison with transesophageal echocardiography and intraoperative findings. J. Am. Coll. Cardiol., February 3, 2009; 53(5): 436 - 444. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||