Computed Tomography Features of Cuspal Thrombosis and Subvalvular Tissue Ingrowth after Transcatheter Aortic Valve Implantation

Abstract

Post-transcatheter aortic valve implantation (TAVI) computed tomography (CT) findings have not been fully elucidated, except hypoattenuating leaflet thickening (HALT). The objective of this study was to describe cardiac CT findings after TAVI, and investigate factors associated with HALT. This retrospective study included patients who underwent TAVI and post-TAVI cardiac CT scans. On CT, abnormal findings such as hypoattenuating subvalvular thickening (HAST), thrombus within the sinus of Valsalva, HALT, and leaflet motion limitation were thoroughly reviewed. Clinical and CT findings were compared between patients with HALT and those without HALT. Logistic regression analysis was performed to determine factors associated with HALT. A total of 138 patients (64 male, mean 78.5±5.2 years of age) with post-TAVI CT scans were included. The median duration from TAVI to CT was 17.5 days (interquartile range, 3 to 390.8 days). HAST and thrombus within the sinus of Valsalva were detected in 32 (23%) and 5 (4%) patients, respectively. HALT and leaflet motion limitations were found in 25 (18%) and 20 (14%) of patients, respectively. Pannus was diagnosed in 2 patients. TAVI device implant duration (odds ratio [OR], 1.5; p=0.01), hypertension (OR, 0.2; p = 0.03), and HAST (OR, 4.9; p = 0.003) were associated with HALT. Implant durations were longer in patients with HAST, HALT, or leaflet motion limitation (p<0.05, for all). In conclusion, HAST, HALT, thrombus within the sinus of Valsalva, and leaflet motion limitation are not uncommon after TAVI. Implant duration, hypertension, and HAST are associated with HALT.