title: Clinical Utility of Multidetector Computed Tomography in Redo Valve Procedures.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) is recommended for diagnosis in patients suspected of prosthetic valve dysfunction, but could be limited in its ability to identify the etiology of these dysfunctions and to assess extracardiac structures. Our objective is to examine the usefulness of multidetector computed tomography (MDCT) in establishing the etiology of the dysfunctions and its clinical utility in preoperative assessment in these patients.
  
  
  METHODS
  Twenty-two prosthetic heart valves from 20 consecutive patients who had a preoperative MDCT and underwent redo prosthetic valve procedures from December 2008 to February 2013 were examined retrospectively. Results from MDCT and TEE were compared to intraoperative findings. Extravalvular MDCT findings including coronary artery/bypass graft, high-risk features for reoperative cardiac surgery, and extracardiac findings were also assessed.
  
  
  RESULTS
  MDCT correctly identified 15 valve regurgitation and seven valve obstructions compared to intraoperative findings. Both TEE and MDCT were able to correctly identify the etiologies in 93% (14/15) of regurgitant valves. However, MDCT was better able to identify the etiology of obstructive valves than TEE (86% [6/7] vs. 43% [3/7]) compared to intraoperative findings. In patients who had preoperative invasive angiography, MDCT correctly identified two patients with significant coronary artery disease (CAD) and ruled out 11 without significant CAD. Furthermore, MDCT detected five high-risk features for postoperative complications and eight clinically relevant extracardiac findings.
  
  
  CONCLUSIONS
  MDCT displayed comparable or better diagnostic performance than TEE for identifying the type of dysfunction and its etiology, as well as providing additional coronary and other extravalvular evaluations useful for preoperative planning.
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Kongkiat
authors.initials: K
authors.lastname: Chaikriangkrai
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Maragiannis
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Belousova
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Stephen
authors.initials: S
authors.lastname: Little
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Faisal
authors.initials: F
authors.lastname: Nabi
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Mahmarian
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000209:etiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012086:Reoperation; D012189:Retrospective Studies