Suchá Dominika, Chamuleau Steven A J, Symersky Petr, Meijs Matthijs F L, van den Brink Renee B A, de Mol Bas A J M, Mali Willem P Th M, Habets Jesse, van Herwerden Lex A, Budde Ricardo P J
Department of Radiology, University Medical Center Utrecht, Huispostnummer E01.132, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Radiol. 2016 Apr;26(4):997-1006. doi: 10.1007/s00330-015-3918-6. Epub 2015 Oct 16.
Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation.
Patients were prospectively enrolled and TTE was performed according to clinical guidelines. 256-MDCT images were systematically assessed for leaflet excursions, image quality, valve-related artefacts, and pathological and additional findings.
Forty-six patients were included comprising 33 mechanical and 16 biological PHVs. Overall, MDCT image quality was good and relevant regions remained reliably assessable despite mild-moderate PHV-artefacts. MDCT detected three unexpected valve-related pathology cases: (1) prominent subprosthetic tissue, (2) pseudoaneurysm and (3) extensive pseudoaneurysms and valve dehiscence. The latter patient required valve surgery to be redone. TTE only showed trace periprosthetic regurgitation, and no abnormalities in the other cases. Additional findings were: tilted aortic PHV position (n = 3), pericardial haematoma (n = 3) and pericardial effusion (n = 3). Periaortic induration was present in 33/40 (83 %) aortic valve patients.
MDCT allowed evaluation of relevant PHV regions in all valves, revealed baseline postsurgical findings and, despite normal TTE findings, detected three cases of unexpected, clinically relevant pathology.
• Postoperative MDCT presents baseline morphology relevant for prosthetic valve follow-up. • 83 % of patients show periaortic induration 6 weeks after aortic valve replacement. • MDCT detected three cases of clinically relevant pathology not found with TTE. • Valve dehiscence detection by MDCT required redo valve surgery in one patient. • MDCT is a suitable and complementary imaging tool for follow-up purposes.
近期研究提出采用多排螺旋CT（MDCT）来评估人工心脏瓣膜（PHV）功能障碍。但目前缺乏关于植入后早期区分生理性与病理性情况的相关参考资料。我们展示了人工心脏瓣膜植入6周后的MDCT基线检查结果。
前瞻性纳入患者，并根据临床指南进行经胸超声心动图（TTE）检查。对256层MDCT图像系统评估瓣叶活动、图像质量、瓣膜相关伪影以及病理性和其他发现。
纳入46例患者，其中包括33枚机械瓣和16枚生物瓣。总体而言，MDCT图像质量良好，尽管存在轻至中度瓣膜相关伪影，但相关区域仍可可靠评估。MDCT检测到3例意外的瓣膜相关病理情况：（1）假体周围组织突出；（2）假性动脉瘤；（3）广泛假性动脉瘤和瓣膜裂开。后一例患者需要再次进行瓣膜手术。TTE仅显示微量人工瓣膜周反流，其他病例未发现异常。其他发现包括：主动脉人工心脏瓣膜位置倾斜（n = 3）、心包血肿（n = 3）和心包积液（n = 3）。40例主动脉瓣患者中有33例（83%）存在主动脉周围硬化。
MDCT可对所有瓣膜的相关区域进行评估，揭示术后基线检查结果，并且尽管TTE检查结果正常，但仍检测到3例意外的、具有临床相关性的病理情况。
• 术后MDCT呈现与人工瓣膜随访相关的基线形态。• 83%的患者在主动脉瓣置换术后6周出现主动脉周围硬化。• MDCT检测到3例TTE未发现的具有临床相关性的病理情况。• MDCT检测到的瓣膜裂开致使1例患者需要再次进行瓣膜手术。• MDCT是用于随访的合适且具有补充作用的成像工具。
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