title: Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve.
abstract: The clinical significance of pannus detected on computed tomography (CT) has not yet been investigated. The purposes of this study were to investigate the clinical significance of pannus detected on cardiac CT in patients who underwent aortic valve replacement (AVR) with mechanical valves, and to determine predictors for pannus severity. A total of 92 patients who underwent cardiac CT and TTE and who had undergone mechanical AVR were included. The geometric orifice area (GOA), the presence of limitation of motion (LOM) and pannus were evaluated on CT. The GOA, presence of LOM, and presence and severity of pannus were compared with echocardiographic parameters. Logistic regression analysis was performed to determine the predictors for pannus severity. The GOA on CT positively correlated with effective orifice area on TTE (r = 0.733, P < 0.0001). Pannus was found in 77.2% and LOM in 14.0%. With increasing pannus severity, mean transvalvular pressure gradient (PG) was significantly higher (P < 0.0001). Patients with elevated PG showed a smaller GOA, a higher incidence of pannus, more severe pannus and LOM than patients with normal PG (P < 0.05). Small valve size (≤19 mm), Carbomedics valve, rheumatic etiology, and young age at AVR (<48.8 years) were independent predictors of moderate to severe pannus (P < 0.05). Cardiac CT is helpful in the evaluation of pannus formation in patients with mechanical aortic valves. Moderate to severe pannus formation frequently occurred in patients with small mechanical valve size, Carbomedics valves, rheumatic heart disease and young age at AVR.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Suh
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sak
authors.initials: S
authors.lastname: Lee
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome