Abstract
Prosthetic valve (PV) dysfunction (PVD) is a complication of mechanical or biological PV. Etiologic mechanisms associated with PVD include fibrotic pannus ingrowth, thrombosis, structural valve degeneration, and endocarditis resulting in different grades of obstruction and/or regurgitation. PVD can be life threatening and often challenging to diagnose due to the similarities between the clinical presentations of different causes. Nevertheless, identifying the cause of PVD is critical to treatment administration (thrombolysis, surgery, or percutaneous procedure). In this report, we review the role of multimodality imaging in the diagnosis of PVD. Specifically, this review discusses the characteristics of advanced imaging modalities underlying the importance of an integrated approach including 2D/3D transthoracic and transesophageal echocardiography, fluoroscopy, and computed tomography. In this scenario, it is critical to understand the strengths and weaknesses of each modality according to the suspected cause of PVD. In conclusion, for patients with suspected or known PVD, this stepwise imaging approach may lead to a simplified, more rapid, accurate and specific workflow and management.
Highlights
Prosthetic valve (PV) dysfunction (PVD) is relatively rare yet potentially life-threatening. often challenging, establishing the exact cause of PVD is essential to determine the appropriate treatment strategy
Despite echocardiography often leading to a conclusive diagnosis, fluoroscopy, multidetector computed tomography (CT), cardiac magnetic resonance (CMR), and, to a lesser extent, nuclear imaging are all complementary tools for the diagnosis and management of PV complications
Whilst the risk of thrombosis and thromboembolic events is higher in mitral versus aortic PV, recent data from CT imaging studies show that mechanical and biological prosthetic aortic valve thrombosis and pannus are relatively common phenomena that might be associated with an increased risk of stroke [14,15] (Figure 2)
Summary
Prosthetic valve (PV) dysfunction (PVD) is relatively rare yet potentially life-threatening. Echocardiography is the first step examination and may be performed in every setting including outpatient laboratories, emergency departments and operating theatres. Both TTE and TEE may be carried out in cases of stable or unstable hemodynamic conditions. The main causes of PVD leading to surgical PV reoperation are: thrombus/pannus prosthetic obstruction; paravalvular leak (PVL); bioprosthetic structural valve degeneration (SVD); and PV endocarditis (PVE). Doppler-derived parameters in prosthetic mitral valve evaluation include: early peak mitral velocity (E wave); mean transprosthetic gradient (∆Pmean ); pressure half time (PHT); and Doppler velocity index (DVI). The present review discusses recommendations for the use of multimodality imaging in the assessment of PVD
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