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Prosthetic Valve Complications
Suhny Abbara, MD, FACR, FSCCT; Arzu Canan, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Prosthetic valve dysfunction (PVD)
        • Definitions

          • Dysfunction depends on prosthesis type
            • Mechanical prostheses
              • Caged-ball valve (Starr-Edwards): Oldest
              • Tilting disc (Lillehei-Kaster, Björk-Shiley, Medtronic-Hall)
              • Bileaflet (St. Jude, On-X): Currently most commonly implanted, lowest thrombogenicity
            • Bioprostheses (tissue valves): Either stented or nonstented
              • Homograft
              • Xenograft-porcine: Hancock, Carpentier-Edwards, Medtronic-Intact
              • Autograft (Ross procedure: Pulmonary valve into aortic position)
              • Catheter delivered (Edwards SAPIEN, CoreValve)
              • Sutureless (Percival S, 3F Enable)

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        • Fluoroscopic Findings

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Rashid HN et al: Subclinical leaflet thrombosis in transcatheter aortic valve replacement detected by multidetector computed tomography - a review of current evidence. Circ J. 82(7):1735-42, 2018
                                            2. Jilaihawi H et al: Systematic CT methodology for the evaluation of subclinical leaflet thrombosis. JACC Cardiovasc Imaging. 10(4):461-70, 2017
                                            3. Lancellotti P et al: Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 17(6):589-90, 2016
                                            4. Moss AJ et al: Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction. Open Heart. 3(2):e000494, 2016
                                            5. Habib G et al: 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 36(44):3075-128, 2015
                                            6. Saby L et al: Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 61(23):2374-82, 2013
                                            7. Habets J et al: Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics. 32(7):1893-905, 2012
                                            8. Jilaihawi H et al: Meta-analysis of complications in aortic valve replacement: comparison of Medtronic-Corevalve, Edwards-Sapien and surgical aortic valve replacement in 8,536 patients. Catheter Cardiovasc Interv. 80(1):128-38, 2012
                                            9. Pham N et al: Complications of aortic valve surgery: manifestations at CT and MR imaging. Radiographics. 32(7):1873-92, 2012
                                            10. Feuchtner GM et al: Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 53(5):436-44, 2009
                                            11. Leborgne L et al: Usefulness of ECG-gated multi-detector computed tomography for the diagnosis of mechanical prosthetic valve dysfunction. Eur Heart J. 27(21):2537, 2006
                                            12. Mollet NR et al: High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 112(15):2318-23, 2005
                                            13. Teshima H et al: Detection of pannus by multidetector-row computed tomography. Ann Thorac Surg. 75(5):1631-3, 2003
                                            14. Thai HM et al: Prosthetic heart valves. In Alpert JS et al: Valvular Heart Disease. 3rd ed. Philadelphia: Lippincott William & Wilkins, 2000
                                            15. Otto CM: Prosthetic valves. In Otto CM: Valvular Heart Disease. 1st ed. Philadelphia: W. B. Saunders, 1999
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Prosthetic valve dysfunction (PVD)
                                                  • Definitions

                                                    • Dysfunction depends on prosthesis type
                                                      • Mechanical prostheses
                                                        • Caged-ball valve (Starr-Edwards): Oldest
                                                        • Tilting disc (Lillehei-Kaster, Björk-Shiley, Medtronic-Hall)
                                                        • Bileaflet (St. Jude, On-X): Currently most commonly implanted, lowest thrombogenicity
                                                      • Bioprostheses (tissue valves): Either stented or nonstented
                                                        • Homograft
                                                        • Xenograft-porcine: Hancock, Carpentier-Edwards, Medtronic-Intact
                                                        • Autograft (Ross procedure: Pulmonary valve into aortic position)
                                                        • Catheter delivered (Edwards SAPIEN, CoreValve)
                                                        • Sutureless (Percival S, 3F Enable)

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Echocardiographic Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  • Fluoroscopic Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Rashid HN et al: Subclinical leaflet thrombosis in transcatheter aortic valve replacement detected by multidetector computed tomography - a review of current evidence. Circ J. 82(7):1735-42, 2018
                                                                                      2. Jilaihawi H et al: Systematic CT methodology for the evaluation of subclinical leaflet thrombosis. JACC Cardiovasc Imaging. 10(4):461-70, 2017
                                                                                      3. Lancellotti P et al: Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 17(6):589-90, 2016
                                                                                      4. Moss AJ et al: Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction. Open Heart. 3(2):e000494, 2016
                                                                                      5. Habib G et al: 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 36(44):3075-128, 2015
                                                                                      6. Saby L et al: Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 61(23):2374-82, 2013
                                                                                      7. Habets J et al: Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics. 32(7):1893-905, 2012
                                                                                      8. Jilaihawi H et al: Meta-analysis of complications in aortic valve replacement: comparison of Medtronic-Corevalve, Edwards-Sapien and surgical aortic valve replacement in 8,536 patients. Catheter Cardiovasc Interv. 80(1):128-38, 2012
                                                                                      9. Pham N et al: Complications of aortic valve surgery: manifestations at CT and MR imaging. Radiographics. 32(7):1873-92, 2012
                                                                                      10. Feuchtner GM et al: Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 53(5):436-44, 2009
                                                                                      11. Leborgne L et al: Usefulness of ECG-gated multi-detector computed tomography for the diagnosis of mechanical prosthetic valve dysfunction. Eur Heart J. 27(21):2537, 2006
                                                                                      12. Mollet NR et al: High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 112(15):2318-23, 2005
                                                                                      13. Teshima H et al: Detection of pannus by multidetector-row computed tomography. Ann Thorac Surg. 75(5):1631-3, 2003
                                                                                      14. Thai HM et al: Prosthetic heart valves. In Alpert JS et al: Valvular Heart Disease. 3rd ed. Philadelphia: Lippincott William & Wilkins, 2000
                                                                                      15. Otto CM: Prosthetic valves. In Otto CM: Valvular Heart Disease. 1st ed. Philadelphia: W. B. Saunders, 1999