Abstract
Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis.For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac infections. Evidence for the additional value of 3D-TEE is scarce.As clinical implications are major, clinicians should have a low threshold to perform additional MDCT in acquired mechanical PHV obstruction. For suspected PHV endocarditis, both FDG-PET and MDCT have complementary value.
Highlights
Valvular heart disease often requires prosthetic heart valve (PHV) replacement in order to improve quality of life and survival
The number of PHV implantations is expected to rise due to ageing, the growth of the population and the development of catheter-based techniques for valve replacement in patients who were inoperable before these techniques emerged
The objective of this article is to review the additional value of new imaging modalities in the field of PHV endocarditis and obstruction
Summary
Valvular heart disease often requires prosthetic heart valve (PHV) replacement in order to improve quality of life and survival. The major drawback of both mechanical and biological PHVs is development of dysfunction that is accompanied by high morbidity and mortality [1]. Causes of PHV dysfunction can be divided into three main groups that can be subsets of each other: (1) paravalvular leakage, (2) endocarditis and (3) obstruction [2]. Acoustic shadowing and reverberation of the metal of the PHVs hamper reliable imaging by transthoracic and transoesophageal echocardiography (TTE and TEE). For the detection of PHV leakages (not in the context of endocarditis) the combination of TTE and TEE has a high diagnostic accuracy for severity and location (valvular/ paravalvular) and diagnostic dilemmas are mostly solved [3,4,5,6]. PHV endocarditis and obstruction often raise more diagnostic problems even after performing 2D-TTE/TEE [2]. A diagnostic flowchart is provided that can aid in determining when and which modality to use in the clinical work-up of PHV endocarditis and PHV obstruction
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