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You are here: Contents > 2013 > Volume 22 Number 6 November 2013 > DEVICE EVALUATION > Mechanical Valve Evaluation with Four-Dimensional Computed Tomography

Mechanical Valve Evaluation with Four-Dimensional Computed Tomography

Satoshi Numata, Yasushi Tsutsumi, Osamu Monta, Sachiko Yamazaki, Hiroyuki Seo, Shohei Yoshida, Takaaki Samura, Hirokazu Ohashi

Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan

Background and aim of the study: Echocardiography or cinefluoroscopy are standard modalities for evaluating implanted mechanical valve prostheses. The aim of the present study was to evaluate the validity of multidetector computed tomography (MDCT) with three-dimensional image reconstruction in a cine mode (four-dimensional (4D)-CT) for evaluating the functional and morphological findings of implanted mechanical valves.

Methods: A total of 37 patients who had received 45 implanted mechanical valves was studied using electrocardiogram-gated (16- or 256-row) MDCT. The mean age of patients at the MDCT examination was 65.1 ± 10.1 years (range: 0.5-85 years). The series included 18 aortic and 27 mitral mechanical valves, in addition to 36 bileaflet valves and nine monoleaflet valves. Fifteen patients had atrial fibrillation, and seven had permanent pacemaker implantation. Volume-rendering 3D and multiplanar reformations were obtained, and valve leaflet movement was evaluated using reformatted images in a cine mode (4D images). The quality of mechanical valve leaflet visualization

was scored on a four-grade scale (Leaflet index), and the level of artifact was also scored (Artifact index).

Results: There were two stuck-valve patients who required emergency surgery. Stuck mechanical leaflets could be visualized using 4D-CT. In all of the bileaflet mechanical valves the valve leaflet motions were visualized with 4D images. In contrast, in four of nine valves with monoleaflet valves the opening and closing angles could not be visualized because of radio-opacity of the leaflet. The median Leaflet index was 3.7 ± 0.8, and the median Artifact index 3.0 ± 0.8. The Leaflet and Artifact indices were significantly lower in monoleaflet valves (p <0.0001, p = 0.0037, respectively). When using 256-row MDCT the Artifact index was superior to that achieved with 16-row MCDT, but was without statistical difference (p = 0.0654).

Conclusion: Functional and morphological evaluations of mechanical valves with 4D-MDCT is promising in patients with bileaflet mechanical valves. However, the evaluation of monoleaflet valves is limited.

The Journal of Heart Valve Disease 2013;22:837-842

Mechanical Valve Evaluation with Four-Dimensional Computed Tomography

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