title: Diagnostic evaluation and treatment strategy in patients with suspected prosthetic heart valve dysfunction: The incremental value of MDCT.
abstract: BACKGROUND
  In patients with suspected prosthetic heart valve (PHV) dysfunction, routine evaluation echocardiography and fluoroscopy may provide unsatisfactory results for identifying the cause of dysfunction. This study assessed the value of MDCT as a routine, complementary imaging modality in suspected PHV-dysfunction for diagnosing the cause of PHV dysfunction and proposing a treatment strategy.
  
  
  METHODS
  Patients with suspected PHV dysfunction were prospectively recruited. All patients underwent routine diagnostic work-up (TTE, TEE ± fluoroscopy) and additional MDCT imaging. An expert panel reviewed all cases and assessed the diagnosis and treatment strategy, first based on routine evaluation only, second with additional MDCT information.
  
  
  RESULTS
  Forty-two patients were included with suspected PHV obstruction (n = 30) and PHV regurgitation (n = 12). The addition of MDCT showed incremental value to routine evaluation in 26/30 (87%) cases for detecting the specific cause of PHV obstruction and in 7/12 (58%) regurgitation cases for assessment of complications and surgical planning. The addition of MDCT resulted in treatment strategy change in 8/30 (27%) patients with suspected obstruction and 3/12 (25%) patients with regurgitation.
  
  
  CONCLUSIONS
  In addition to echocardiography and fluoroscopy, MDCT may identify the cause of PHV dysfunction and alter the treatment strategy.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: d.sucha@umcutrecht.nl.
authors.forename: Dominika
authors.initials: D
authors.lastname: Suchá
authors.affiliation: Department of Cardiothoracic Surgery, VU Medical Center, PO Box 7057, 1081 HV Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Petr
authors.initials: P
authors.lastname: Symersky
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Renee B A
authors.initials: RB
authors.lastname: van den Brink
authors.affiliation: Department of Cardiology, HagaZiekenhuis, PO Box 40551, 2504 LN Den Haag, The Netherlands.
authors.forename: Wilco
authors.initials: W
authors.lastname: Tanis
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Eduard M
authors.initials: EM
authors.lastname: Laufer
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands.
authors.forename: Matthijs F L
authors.initials: MF
authors.lastname: Meijs
authors.affiliation: Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Jesse
authors.initials: J
authors.lastname: Habets
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Steven A J
authors.initials: SA
authors.lastname: Chamuleau
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.affiliation: Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055424:Cardiac-Gated Imaging Techniques; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D061330:Multidetector Computed Tomography; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Computed tomography; Dysfunction; Echocardiography; Heart valve prosthesis; Obstruction