Fig 7 - uploaded by Mohamed-Salah Annabi
Content may be subject to copyright.
3 Imaging features of prosthesis-patient mismatch. A transcatheter aortic valve prosthesis (SAPIEN XT 20 mm) with normal morphology and mobility of valve leaflets in parasternal long axis view in systole (Panel a) and a mechanical prosthesis (Carbomedics 19 mm) with normal leaflet motion as shown by cinefluoroscopy in diastole (Panel c) and systole (Panel d). Both valves had elevated transprosthetic gradients (Panel b: mean gradient 26 mmHg and Panel E: 39 mmHg, respectively) with a triangular shaped continuous wave Doppler velocity envelope and early peaking velocity. The acceleration time to LV ejection time ratio was <0.37 in both cases. The valve EOA calculated by continuity equation was 1.2 cm 2 (Doppler velocity index 0.35) for the SAPIEN XT valve and 1.06 cm 2 (Doppler velocity index: 0.32) for the mechanical Carbomedics 19 mm valve. These EOAs are within normal range. However, the indexed EOAs were <0.65 cm 2 /m 2 (0.63 cm 2 /m 2 and 0.53 cm 2 /m 2 , respectively). All these imaging findings are consistent with the presence of severe prosthesis-patient mismatch
Source publication
Doppler-echocardiography is the primary imaging modality to assess the structural and functional integrity of aortic prosthetic heart valves (PHVs). A comprehensive approach that integrates several parameters of PHV structure and function measured in multiple views by transthoracic (TTE) or transoesophageal (TEE) echocardiography is essential to ap...
Contexts in source publication
Context 1
... of the key imaging points to distinguish PPM from acquired PHV stenosis is to assess valve leaflet morphology and mobility (Fig. 7.3). TTE, TEE, cinefluoroscopy (mechanical valves) and/or MDCT can be used for this purpose (Table 7.2, Fig. 7.3). ...
Similar publications
Cardiac papillary fibroelastoma (CPF) is the second most common primary cardiac tumor, which is diagnosed incidentally or with embolic phenomena, mostly in the form of a transient ischemic attack (TIA) and stroke. We present a case of a 58-year-old female who presented with fatigue and low-grade fever and was found to have multiple systemic infarct...
Aims:
Limited contemporary data are available on the clinical and echocardiographic outcomes after surgery for cardiac papillary fibroelastoma (CPF). The aim of this study was to review the clinical manifestations, pathological characteristics, surgical management, and prognoses of patients with histologically verified CPF, who underwent surgery a...
Background:
Aortic valve sparing surgery (AVS), in combination with aortic cusp repair (ACR), still raises many questions about the increased surgical complexity and applicability for patients with pure aortic valve regurgitation (AR). The aim of this study was to investigate our long-term outcomes and predictors of recurrent AR (> 2+) after AVS a...
![Fig. 2. Image-TTE Parasternal long axis [PLAX] view showing...](publication/328559745/figure/fig2/AS:873424385761294@1585252009322/Image-TTE-Parasternal-long-axis-PLAX-view-showing-paravalvular-regurgitation_Q320.jpg)
Dehiscence of mechanical prosthetic valve is rare complication reported in 0.1–1.3% of patients undergoing valve replacement with infective endocarditis being the commonest cause.1,2 In spite of rapid diagnosis and prompt initiation of treatment, outcome is often poor due to fulminant course of the disease. Transthoracic echocardiography (TTE) and...
Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly with prevalence less than 0.01% in autopsy series. It can be found as an isolated anomaly, and the patient may be asymptomatic, but is often associated with aortic insufficiency in 68% of the cases. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) ar...
Citations
... ECG-gated multidetector CT (MDCT) is becoming a useful technique for the evaluation of cardiac anatomy, with an increasingly solid evidence-based role [2]. Multidetector and dual-source scanners are able to provide a broader coverage with faster scan acquisition times that yield higher spatial and temporal resolution for cardiac structures. ...
... In addition to its powerful diagnostic accuracy in coronary artery disease, a growing indication of MDCT is the assessment of native and prosthetic heart valves (PHVs). In the latter case, several artifacts, such as mechanical acoustic shadowing, reverberations, refraction and mirroring, may develop, affecting the imaging quality on ultrasound (US) [2][3][4]. In patients with PHVs, dynamic 4D imaging provided by MDCT can provide detailed information about the morphology and mobility of the PHV's elements, detecting the cause of valve dysfunction (thrombus, pannus, calcific degeneration of PHV leaflets) and quantifying its severity [2][3][4][5][6][7][8], despite the fact that image quality may be affected by beam hardening and cardiac motion artifacts. ...
... In the latter case, several artifacts, such as mechanical acoustic shadowing, reverberations, refraction and mirroring, may develop, affecting the imaging quality on ultrasound (US) [2][3][4]. In patients with PHVs, dynamic 4D imaging provided by MDCT can provide detailed information about the morphology and mobility of the PHV's elements, detecting the cause of valve dysfunction (thrombus, pannus, calcific degeneration of PHV leaflets) and quantifying its severity [2][3][4][5][6][7][8], despite the fact that image quality may be affected by beam hardening and cardiac motion artifacts. ...
ECG-gated multidetector computed tomography (MDCT) is a promising complementary technique for evaluation of cardiac native and prosthetic structures. MDCT is able to provide a broader coverage with faster scan acquisition times that yield higher spatial and temporal resolution for cardiac structures whose quality may be affected by artifacts on ultrasound. We report a case series about the most challenging complications occurring after prosthetic aortic valve implantation in four patients: pannus, paravalvular leak, prosthesis’ misfolding and subaortic membrane reformation. In all the cases, enhanced MDCT using a retrospective protocol provided accurate 3D morphoanatomic information about cardiac and extracardiac structures, improving and speeding up the correct diagnosis and treatment planning. Integrated imaging, in particular with MDCT, is now the present, and it will increasingly be the future in the assessment of cardiac structural pathology.
... In the current, ECG-gated multi-detector CT (MDCT) is becoming a widespread technique for the detection of CAA, with an increasingly solid evidence-based role [4]. Its multi-planar capability allows a precise visualization of the origin, course, and termination of vessels. ...
SCA from the right sinus is the rarest coronary anomaly. We describe 2 cases: 1 with SCA type-1RI; 2 with SCA type-2RII-A. Appropriate and successful treatment (CABG in case-1; PTCA in case-2) was chosen relying on accurate morphological description provided by MDCT, in order to recognize all the possible mechanisms of myocardial ischemia.
... small AVA with low gradient) at dobutamine stress echocardiography, it is useful to calculate the projected AVA at normal flow rate (i.e. a flowindependent parameter); a projected AVA < 1.0 cm 2 suggests true severe stenosis (Figs. 3.5 and 3.6 and Table 3.1) [51,52]. Patients with no or minimal increase in stroke volume (percent increase <20%) with dobutamine have a high risk of early mortality with SAVR but not with TAVI [53,54]. ...
Calcific aortic stenosis (AS) is a slowly progressive disease that is characterized by fibro-calcific remodeling and stiffening of valve leaflets, which cause progressive obstruction of LV outflow. AS is the second most frequent cardiovascular disease after coronary artery disease and hypertension with a prevalence of 0.4% in the general population and 1.7% in the population over 65 years old. Congenital abnormality (bicuspid valve) and older age are the most important risk factors for AS. The pathobiology of AS is complex and involves genetic factors, lipoprotein deposition and oxidation, chronic inflammation, osteoblastic transition of valvular interstitial cells, apoptosis, and active leaflet calcification. Until now, no pharmacotherapy has proven to be effective in reducing the progression of AS. Promising therapeutic targets include Lipoprotein (a), renin-angiotensin system, and Palmdelphin. For now, aortic valve replacement (AVR) remains the sole effective option for the treatment of severe AS. AVR is indicated in presence of: (i) severe AS and (ii) symptoms and/or LV systolic dysfunction. The grading of AS severity and staging of associated cardiac damage are primarily based on Doppler-echocardiography but other imaging modalities such as multi-detector computed tomography that may provide important complementary information, particularly in patients with low-gradient AS. The introduction of transcatheter AVR in the past decade has been a transformative innovation for patients at extreme, high, or intermediate surgical risk and this new technology may extend to low risk patients in the near future.
