Assessment of Mitral Paravalvular Leakage After Mitral Valve Replacement Using Cardiac Computed Tomography: Comparison With Surgical Findings.
BACKGROUND
The diagnostic performance of cardiac computed tomography (CT) for detection of paravalvular leakage (PVL) after mitral valve replacement has not been investigated in a large population. We aimed to investigate the diagnostic accuracy of CT for diagnosis of mitral PVL using surgical findings as the standard reference and to compare the diagnostic performance of CT with those of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE).


RESULTS
A total of 204 patients with previous mitral valve replacement who underwent cardiac CT were retrospectively included. The presence of mitral PVL was analyzed on CT, TTE, and TEE. In 78 patients who underwent redo-surgery, diagnostic performance for the detection of PVL for CT, TTE, and TEE were compared with surgical findings as the standard reference. The location of mitral PVL on CT and TEE was compared with surgical findings. Mitral PVL was present in 18.1% (37/204) on CT, in 16.2% (32/198) on TTE, and in 42.6% (29/68) on TEE. On the surgical field, PVL was identified in 41.0% (32/78). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of PVL were 96.9%, 97.8%, 96.9%, 97.8%, and 97.4% for CT; 81.3%, 95.6%, 92.9%, 87.8%, and 89.6% for TTE; and 96.2%, 95.8%, 96.2%, 95.8%, and 96.0% for TEE. CT and TEE identified the correct location of PVL in 75.9% (22/29) and 85.6% (19/23).


CONCLUSIONS
Cardiac CT may have better diagnostic accuracy compared with TTE for the detection of mitral PVL and may be comparable to TEE for the detection and localization of PVL.
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Young Joo
YJ
Suh
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Geu-Ru
GR
Hong
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Kyunghwa
K
Han
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Dong Jin
DJ
Im
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Suyon
S
Chang
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Yoo Jin
YJ
Hong
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Hye-Jeong
HJ
Lee
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Jin
J
Hur
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Byoung Wook
BW
Choi
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Byung-Chul
BC
Chang
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea. dryj@yuhs.ac cysprs@yuhs.ac.
Chi Young
CY
Shim
From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Y.J.S., K.H., D.J.I., S.C., Y.J.H., H.-J.L., J.H., B.W.C., Y.J.K.), Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital (G.-R.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (B.-C.C.), and Biostatistics Collaboration Unit (K.H.), Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea. dryj@yuhs.ac cysprs@yuhs.ac.
Young Jin
YJ
Kim
D000328:Adult; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
computed tomography; diagnosis; mitral valve; paravavular regurgitation; valve replacement