title: Practical tips and tricks for assessing prosthetic valves and detecting paravalvular regurgitation using cardiac CT.
abstract: Paravalvular leaks are an uncommon but serious complication of prosthetic valves. Transthoracic echocardiography is used in the assessment of prosthetic valves but can be limited by acoustic shadowing from the prosthesis and poor acoustic windowing. Small case series have previously shown cardiac CT to have promising results in detecting paravalvular leaks. We assessed 32 valves in our institution on cardiac CT using echocardiography results as standard and developed methods for improved evaluation of prosthetic valves. These include optimizing prescan drug therapy for heart rate control, optimum window and center adjustments, and carefully selected image planes to best demonstrate the valve ring and valve annulus. Recognition of surgical material is also important to recognize. In this review, we provide a detailed description of these techniques with imaging examples of prosthetic valve evaluation using cardiac CT.
authors.affiliation: Cardiac CT/MRI Program, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Ailbhe C
authors.initials: AC
authors.lastname: O'Neill
authors.affiliation: Cardiac CT/MRI Program, Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Ramon
authors.initials: R
authors.lastname: Martos
authors.affiliation: Cardiac CT/MRI Program, Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Gillian
authors.initials: G
authors.lastname: Murtagh
authors.affiliation: Cardiac CT/MRI Program, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Edmund Ronan
authors.initials: ER
authors.lastname: Ryan
authors.affiliation: Cardiac CT/MRI Program, Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: McCreery
authors.affiliation: Cardiac CT/MRI Program, Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Keane
authors.affiliation: Cardiac CT/MRI Program, Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: Quinn
authors.affiliation: Cardiac CT/MRI Program, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: j.dodd@st-vincents.ie.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Dodd
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D016477:Artifacts; D018618:Echocardiography, Doppler, Color; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011857:Radiographic Image Interpretation, Computer-Assisted
keywords: Cardiac CT; Paravalvular leak; Prosthetic valve; Transthoracic echocardiography