title: Sixty-Four-Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction: Thrombus or Pannus.
abstract: BACKGROUND
  Distinguishing pannus and thrombus in patients with prosthetic valve dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis.
  
  
  RESULTS
  Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical prosthetic valve dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. Periprosthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P<0.001). Area under the receiver operating characteristic curve was 0.96 (95% confidence interval: 0.91-0.99; P<0.001), and a cutoff point of HU≥145 provided high sensitivity (87.5%) and specificity (95.5%) in discriminating pannus from thrombus. Complete lysis was more common for masses with HU<90 compared with those with HU 90 to 145 (100% versus 42.1%; P=0.007).
  
  
  CONCLUSIONS
  Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with prosthetic valve dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates.
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.). sabahattingunduz@yahoo.com.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Gündüz
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Mehmet
authors.initials: M
authors.lastname: Özkan
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Macit
authors.initials: M
authors.lastname: Kalçik
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Ozan Mustafa
authors.initials: OM
authors.lastname: Gürsoy
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Astarcioğlu
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Süleyman
authors.initials: S
authors.lastname: Karakoyun
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Ahmet Çağri
authors.initials: AÇ
authors.lastname: Aykan
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Hasan
authors.initials: H
authors.lastname: Kaya
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yesin
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Nilüfer Ekşi
authors.initials: NE
authors.lastname: Duran
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Deniz
authors.initials: D
authors.lastname: Sevinç
authors.affiliation: From the Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey (S.G., M.Ö., M.K., O.M.G., M.A.A., S.K., A.Ç.A., M.B., T.G., H.K., M.Y., N.E.D.); Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey (M.Ö.); and Department of CT Coronary Angiography, Sonomed Imaging Center, İstanbul, Turkey (D.S., T.G.).
authors.forename: Tahsin
authors.initials: T
authors.lastname: Güneysu
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006351:Heart Valves / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012372:ROC Curve; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: multidetector computed tomography; prosthetic heart valves; sensitivity and specificity; thrombosis; transesophageal echocardiography