Abdelghani Mohammad, Abdelfattah Mohamed, Diab Ahmed Mohamed, Elsheikh Hamada, Elabbady Mohy E Mansour
Cardiology Department, Al-Azhar University, Cairo, Egypt.
Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Heart Vessels. 2023 Apr;38(4):599-605. doi: 10.1007/s00380-022-02193-x. Epub 2022 Oct 27.
Evaluation of mechanical prosthetic valve function is based on echocardiography, but adequate assessment of leaflet motion is limited by acoustic shadowing. Cinefluoroscopy is a standard method to assess leaflet motion, while computed tomography (CT) has been suggested as an alternative. We sought to compare the feasibility of leaflet motion assessment by cinefluoroscopy vs. CT. In 35 prospectively enrolled patients, leaflet motion was assessed in 43 bileaflet mechanical prostheses (29 mitral and 14 aortic) by cinefluoroscopy and non-contrast CT. Assessment was considered feasible when the 'in profile' projection (with the radiographic beam parallel to both the valve ring plane and the tilting axis of discs) could be achieved. Overall feasibility of fluoroscopic assessment was 74% (mitral, 66% vs. aortic, 93%; p = 0.071), while feasibility of CT assessment was 100% (p = 0.003). Among prostheses with unfeasible fluoroscopic assessment, CT suggested an extreme C-arm angulation to achieve the "in profile" projection (RAO: 76.0 ± 5.8°, LAO: 122.7 ± 32.5°, CRA: 51.4 ± 16.0°, CAU: 57.0 ± 18.2°). Among prostheses with feasible assessment by both techniques, fluoroscopy and CT yielded similar opening and closing angles (intraclass correlation coefficient, 0.959-0.998) with lower irradiation with CT as compared with fluoroscopy (26.2[21.1-29.3] vs. 289[179-358] mGy, p < 0.001). While CT scan took 8.7 ± 0.5 s, fluoroscopy required 2.64 ± 1.56 min to achieve and record the "in profile" projection. Non-contrast CT provides a higher feasibility and a quicker evaluation of mechanical prosthetic valve leaflet motion with less irradiation than fluoroscopy, especially in mitral valve position.
机械人工瓣膜功能的评估基于超声心动图，但瓣叶运动的充分评估受到声影的限制。电影荧光透视法是评估瓣叶运动的标准方法，而计算机断层扫描（CT）已被提议作为一种替代方法。我们旨在比较电影荧光透视法与CT评估瓣叶运动的可行性。在35例前瞻性纳入的患者中，通过电影荧光透视法和非增强CT对43个双叶机械瓣膜（29个二尖瓣和14个主动脉瓣）的瓣叶运动进行评估。当能够实现“侧面”投影（射线束与瓣环平面和圆盘倾斜轴平行）时，评估被认为是可行的。荧光透视评估的总体可行性为74%（二尖瓣为66%，主动脉瓣为93%；p = 0.071），而CT评估的可行性为100%（p = 0.003）。在荧光透视评估不可行的瓣膜中，CT显示需要极端的C形臂角度才能实现“侧面”投影（右前斜位：76.0±5.8°，左前斜位：122.7±32.5°，头侧位：51.4±16.0°，尾侧位：57.0±18.2°）。在两种技术评估均可行的瓣膜中，荧光透视法和CT得出的开放和关闭角度相似（组内相关系数，0.959 - 0.998），与荧光透视法相比，CT的辐射更低（26.2[21.1 - 29.3] vs. 289[179 - 358] mGy，p < 0.001）。CT扫描需要8.7±0.5秒，而荧光透视法需要2.64±1.56分钟来实现并记录“侧面”投影。非增强CT提供了更高的可行性，并且比荧光透视法能更快地评估机械人工瓣膜瓣叶运动，辐射更少，尤其是在二尖瓣位置。
