title: Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?
abstract: OBJECTIVE
  Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG).
  
  
  METHODS
  PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test.
  
  
  RESULTS
  Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two.
  
  
  CONCLUSIONS
  MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD.
  
  
  CONCLUSIONS
  • Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment • In case of PHV reoperation, invasive coronary angiography is also required • MDCT can replace CAG in 50 % of patients without coronary artery disease • When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate • Replacing CAG saves associated risks of distant embolization of thrombi or vegetations.
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands, w.tanis@hagaziekenhuis.nl.
authors.forename: Wilco
authors.initials: W
authors.lastname: Tanis
authors.forename: Dominika
authors.initials: D
authors.lastname: Suchá
authors.forename: Ward
authors.initials: W
authors.lastname: Laufer
authors.forename: Jesse
authors.initials: J
authors.lastname: Habets
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: Petr
authors.initials: P
authors.lastname: Symersky
authors.forename: Steven
authors.initials: S
authors.lastname: Chamuleau
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D019544:Equipment Failure Analysis / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D006351:Heart Valves / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011475:Prosthesis Failure; D012086:Reoperation; D015203:Reproducibility of Results