Evaluation of mechanical heart valve size and function with ECG-gated 64-MDCT.
OBJECTIVE
The purpose of our study was to determine whether CT can accurately evaluate mechanical heart valve size and function.


METHODS
Sixty-two patients with mechanical valves (37 single-disc, 27 bileaflet; 59 aortic, 5 mitral) were evaluated with ECG-gated 64-MDCT and transthoracic echocardiography; a subset of 10 patients underwent cinefluoroscopy. Two readers independently interpreted each study.


RESULTS
The mean age of the patients was 46.4 +/- 14.4 years; 50 were men and 12 were women. There was excellent correlation, and differences between CT readers were absent to small in measuring the opening angle (r = 0.96, p < 0.001; 76.7 +/- 9.0 degrees vs 76.8 +/- 9.6 degrees , p = 0.73), annulus diameter (r = 0.96, p < 0.001; 25.9 +/- 3.3 vs 25.9 +/- 3.2 mm, p = 0.62), and geometric orifice area (r = 0.98, p < 0.001; 3.8 +/- 0.9 vs 3.6 +/- 0.8 cm(2), p < 0.001). There was strong correlation without difference in opening angle between CT and cinefluoroscopy (r = 0.77, p < 0.001; 79.2 degrees +/- 9.8 degrees vs 77.2 degrees +/- 15.5 degrees , p = 0.45). Compared with manufacturer specifications, CT reported opening angles that were smaller for single-disc valves (n = 36, 67.4 degrees +/- 5.7 degrees vs 75 degrees , p < 0.001) and similar for bileaflet valves (n = 42 for 21 valves, 83.8 degrees +/- 3.9 degrees vs 85 degrees , p = 0.05), valves, with small underestimation with CT versus specifications in annulus diameter (n = 41; r = 0.75, p < 0.001; 26.4 +/- 3.0 vs 27.5 +/- 3.3 mm, p = 0.003), and geometric orifice area (n = 35; r = 0.90, p < 0.001; 3.7 +/- 0.7 vs 3.8 +/- 0.8 cm(2), p = 0.04). Each disc closed fully on CT; none had more than mild regurgitation on echocardiography.


CONCLUSIONS
CT can measure the size and function of mechanical valves with high interobserver agreement and results similar to specifications. The opening angle with CT strongly correlates with cinefluoroscopy. CT is promising for the assessment of mechanical valves.
Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY 10021, USA. tml9001@med.cornell.edu
Troy M
TM
LaBounty
Prachi P
PP
Agarwal
Aamer
A
Chughtai
David S
DS
Bach
Eric
E
Wizauer
Ella A
EA
Kazerooni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*