Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands,
Eur Radiol. 2015 Jun;25(6):1623-30. doi: 10.1007/s00330-014-3551-9. Epub 2014 Dec 14.
Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG).
PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test.
Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two.
MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD.
• Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment • In case of PHV reoperation, invasive coronary angiography is also required • MDCT can replace CAG in 50 % of patients without coronary artery disease • When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate • Replacing CAG saves associated risks of distant embolization of thrombi or vegetations.
回顾性心电门控多层螺旋 CT（MDCT）越来越多地用于评估人工心脏瓣膜（PHV）功能障碍，但也受到 PHV 相关伪影/心律失常的影响。此外，它是在没有硝化甘油或心率校正的情况下进行的。目的是确定在潜在的再次 PHV 手术前进行 MDCT 是否可行，以评估同时存在的冠状动脉狭窄，并可替代有创冠状动脉造影（CAG）。
确定了进行 CAG 和 MDCT 的 PHV 患者。根据病史，创建了两组：（I）无已知冠状动脉疾病（CAD）的患者，（II）已知 CAD 的患者。所有图像均对存在显著（>50%）狭窄进行评分。CAG 为参考测试。
共纳入 51 例患者。在组 I（n=38）中，MDCT 准确排除了 19/38（50%）患者的显著狭窄，但由于非诊断性图像质量（n=16）或显著狭窄（n=3），19/38（50%）患者不能替代 CAG。在组 II（n=13）中，MDCT 正确地发现没有没有显著狭窄的患者，所有患者都需要进行 CAG 成像。MDCT 评估了 16/19（84%）个移植物的通畅性，并发现两个移植物的解剖结构不友好。
对 PHV 功能障碍评估进行的 MDCT 可在大约一半无先前已知 CAD 的患者中替代 CAG（100%准确）。
• 回顾性 MDCT 越来越多地用于人工心脏瓣膜功能障碍的评估 • 在 PHV 再次手术的情况下，也需要进行有创冠状动脉造影 • MDCT 可替代无 CAD 患者的 CAG（50%） • 当对冠状动脉评估具有结论性时，MDCT 狭窄排除的准确性很高 • 替代 CAG 可避免血栓或赘生物的远处栓塞相关风险。
