Yale School of Medicine, Yale University, 135 College Street, Suite 101, New Haven, CT 06510, USA.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Prog Cardiovasc Dis. 2022 May-Jun;72:78-83. doi: 10.1016/j.pcad.2022.05.007. Epub 2022 Jun 5.
Transcatheter aortic valve implantation is a safe and effective therapy for patients with symptomatic severe aortic stenosis, with randomized data demonstrating outcomes at least equivalent to surgical aortic valve replacement across the spectrum of surgical risk. There has been substantial recent interest in the occurrence of hypoattenuated leaflet thickening and reduced leaflet motion, which are imaging features detected on computed tomography of patients who have received aortic bioprostheses. These phenomena may represent subclinical leaflet thrombosis with theoretical potential downstream effects on valve durability or thrombotic complications in the form of stroke. This review will discuss definitions, predictors, mechanisms, diagnosis, and natural history. We will also examine the frequency with which hypoattenuated leaflet thickening and reduced leaflet motion occur after both transcatheter and surgical aortic bioprostheses, and the clinical implications and potential impact on valve function, as well as strategies for prophylaxis and treatment.
经导管主动脉瓣植入术是一种安全有效的治疗方法，适用于有症状的严重主动脉瓣狭窄患者，随机数据表明，在整个手术风险范围内，其结果至少与外科主动脉瓣置换术相当。最近，人们对经主动脉生物瓣患者 CT 检测到的低衰减瓣叶增厚和瓣叶运动减少的情况产生了浓厚的兴趣。这些现象可能代表亚临床瓣叶血栓形成，理论上可能对瓣膜耐久性或血栓并发症（如中风）产生下游影响。本文将讨论这些现象的定义、预测因素、机制、诊断和自然史。我们还将检查经导管和外科主动脉生物瓣植入后低衰减瓣叶增厚和瓣叶运动减少的发生频率，以及它们对瓣膜功能的临床意义和潜在影响，以及预防和治疗策略。
