title: Novel imaging strategies for the detection of prosthetic heart valve obstruction and endocarditis.
abstract: Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis.For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac infections. Evidence for the additional value of 3D-TEE is scarce.As clinical implications are major, clinicians should have a low threshold to perform additional MDCT in acquired mechanical PHV obstruction. For suspected PHV endocarditis, both FDG-PET and MDCT have complementary value.
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands. w.tanis@hagaziekenhuis.nl.
authors.forename: W
authors.initials: W
authors.lastname: Tanis
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: R P J
authors.initials: RP
authors.lastname: Budde
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: I A C
authors.initials: IA
authors.lastname: van der Bilt
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Delemarre
authors.affiliation: Department of Cardiothoracic Surgery, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Hoohenkerk
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: J-K
authors.initials: JK
authors.lastname: van Rooden
authors.affiliation: Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Scholtens
authors.affiliation: Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Habets
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Chamuleau
keywords: 18-fluorine-fluorodesoxyglucose positron emission tomography; Endocarditis; Multidetector-row computed tomography; Pannus; Prosthetic heart valve; Thrombosis