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Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

  • Cardiac
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Abstract

Objectives

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG).

Methods

PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test.

Results

Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two.

Conclusion

MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD.

Key Points

• Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment

• In case of PHV reoperation, invasive coronary angiography is also required

• MDCT can replace CAG in 50 % of patients without coronary artery disease

• When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate

• Replacing CAG saves associated risks of distant embolization of thrombi or vegetations

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Abbreviations

CAD:

coronary artery disease

CABG:

coronary artery bypass grafts

CAG:

invasive coronary angiography

ECG:

electrocardiography

FFR:

flow fractional reserve

LCx:

left circumflex artery

LDA:

left descending artery

LM:

left main

MDCT:

multidetector-row computed tomography

NPV:

negative predictive value

PCI:

percutaneous coronary intervention

PHV:

prosthetic heart valve

PPV:

positive predictive value

RCA:

right coronary artery

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Acknowledgments

We would like to thank Karin van Rijnbach, University Medical Center Utrecht, for her help with preparing the figures.

The scientific guarantor of this publication is Dr. R Budde. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding in the form of a grant from The Dutch Heart Foundation [Grant number 2009B014]. No complex statistical methods were necessary for this paper. Institutional review board approval was not required. Informed consent was waived by the local medical ethical committee as this was a retrospective study. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands

    Wilco Tanis

  2. Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands

    Dominika Suchá & Jesse Habets

  3. Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands

    Ward Laufer & Steven Chamuleau

  4. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands

    Lex. A. van Herwerden

  5. Department of Cardiothoracic Surgery, Vrije Universiteit, Amsterdam, the Netherlands

    Petr Symersky

  6. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

    Ricardo P. J. Budde

  7. Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands

    Wilco Tanis

Authors
  1. Wilco Tanis
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  2. Dominika Suchá
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  3. Ward Laufer
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  4. Jesse Habets
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  5. Lex. A. van Herwerden
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  6. Petr Symersky
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  7. Steven Chamuleau
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  8. Ricardo P. J. Budde
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Corresponding author

Correspondence to Wilco Tanis.

Additional information

Wilco Tanis and Dominika Suchá contributed equally to this paper

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Tanis, W., Suchá, D., Laufer, W. et al. Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?. Eur Radiol 25, 1623–1630 (2015). https://doi.org/10.1007/s00330-014-3551-9

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  • DOI: https://doi.org/10.1007/s00330-014-3551-9

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