Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy.
Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy.
Int J Cardiol. 2024 Mar 1;398:131597. doi: 10.1016/j.ijcard.2023.131597. Epub 2023 Nov 17.
Subclinical leaflet thrombosis is diagnosed using multidetector computed tomography (MDCT) and is characterised by a meniscal-shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self-expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms leaflet and extra-leaflet components such as the valve skirt. Little is known about extra-leaflet hypoattenuated lesion localisation, including that at the anatomical sinus level. Thus, the main aim of this study was to describe leaflet and extra-leaflet (anatomic sinus and subvalvular level) hypoattenuated lesions following transcatheter aortic valve replacement with a self-expandable prosthesis. As a secondary aim, we sought to investigate predictors of hypoattenuated lesions.
Fifty patients underwent MDCT at the follow-up.
At a follow-up of 12 months, hypoattenuated leaflet lesions with mild to severe restricted movement were detected in eight individuals (16%), anatomic sinus lesions were identified in nine patients (18%), with higher prevalence in the non-coronary sinus (16%), and subvalvular lesions with variable extension toward the valve inflow were diagnosed in eight patients (16%). In 4 patients (8%) the anatomic sinus thrombus was 'in overlap' with leaflet thrombus; in 3 patients (6%) was in continuity with subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p = 0.02)).
This study demonstrated that hypoattenuated lesions could be identified not only at the leaflet but also at the subvalvular and anatomic sinus levels. The clinical relevance of such lesions remains unclear.
亚临床瓣叶血栓形成通过多排螺旋 CT（MDCT）诊断，其特征为一个或多个瓣叶出现新月形低衰减病变。经导管主动脉自膨式瓣膜通常采用柔韧的心包膜覆盖在镍钛诺框架上，形成瓣叶和瓣叶外组件，如瓣裙。对于瓣叶外低衰减病变的定位，包括在解剖窦水平的定位，知之甚少。因此，本研究的主要目的是描述经导管主动脉瓣置换术后自膨式瓣膜的瓣叶和瓣叶外（解剖窦和瓣下水平）低衰减病变。次要目的是探讨低衰减病变的预测因素。
50 例患者在随访时进行 MDCT 检查。
在 12 个月的随访中，8 名患者（16%）发现瓣叶低衰减病变伴轻度至重度活动受限，9 名患者（18%）发现解剖窦病变，其中非冠状动脉窦病变发生率较高（16%），8 名患者（16%）诊断为瓣下病变，其向瓣流入道延伸程度不一。4 名患者（8%）的解剖窦血栓与瓣叶血栓“重叠”；3 名患者（6%）与瓣下框架血栓连续。二叶式主动脉瓣是唯一与低衰减病变相关的独立预测因素（校正 OR 8.25（95%CI：1.38，49.21），p=0.02））。
本研究表明，低衰减病变不仅可在瓣叶上，也可在瓣下和解剖窦水平上识别。这些病变的临床意义尚不清楚。
