Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Measurement of Opening and Closing Angles of Aortic Valve Prostheses In Vivo Using Dual-Source Computed Tomography: Comparison with Those of Manufacturers' in 10 Different Types

  • Suh, Young Joo (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Young Jin (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hong, Yoo Jin (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Hye-Jeong (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hur, Jin (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Im, Dong Jin (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Yun Jung (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, Byoung Wook (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2015.02.13
  • Accepted : 2015.06.26
  • Published : 2015.09.01
⟨ Previous Next ⟩

Abstract

Objective: The aims of this study were to compare opening and closing angles of normally functioning mechanical aortic valves measured on dual-source computed tomography (CT) with the manufacturers' values and to compare CT-measured opening angles according to valve function. Materials and Methods: A total of 140 patients with 10 different types of mechanical aortic valves, who underwent dual-source cardiac CT, were included. Opening and closing angles were measured on CT images. Agreement between angles in normally functioning valves and the manufacturer values was assessed using the interclass coefficient and the Bland-Altman method. CT-measured opening angles were compared between normal functioning valves and suspected dysfunctioning valves. Results: The CT-measured opening angles of normally functioning valves and manufacturers' values showed excellent agreement for seven valve types (intraclass coefficient [ICC], 0.977; 95% confidence interval [CI], 0.962-0.987). The mean differences in opening angles between the CT measurements and the manufacturers' values were $1.2^{\circ}$ in seven types of valves, $11.0^{\circ}$ in On-X valves, and $15.5^{\circ}$ in ATS valves. The manufacturers' closing angles and those measured by CT showed excellent agreement for all valve types (ICC, 0.953; 95% CI, 0.920-0.972). Among valves with suspected dysfunction, those with limitation of motion (LOM) and an increased pressure gradient (PG) had smaller opening angles than those with LOM only (p < 0.05). Conclusion: Dual-source cardiac CT accurately measures opening and closing angles in most types of mechanical aortic valves, compared with the manufacturers' values. Opening angles on CT differ according to the type of valve dysfunction and a decreased opening angle may suggest an elevated PG.

Keywords

References

  1. Bach DS. Echo/Doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC Cardiovasc Imaging 2010;3:296-304 https://doi.org/10.1016/j.jcmg.2009.11.009
  2. Carrier M, Pellerin M, Basmadjian A, Bouchard D, Perrault LP, Cartier R, et al. Fifteen years of clinical and echocardiographic follow up with the carbomedics heart valve. J Heart Valve Dis 2006;15:67-72; discussion 72
  3. LaBounty TM, Agarwal PP, Chughtai A, Bach DS, Wizauer E, Kazerooni EA. Evaluation of mechanical heart valve size and function with ECG-gated 64-MDCT. AJR Am J Roentgenol 2009;193:W389-W396 https://doi.org/10.2214/AJR.08.2178
  4. Konen E, Goitein O, Feinberg MS, Eshet Y, Raanani E, Rimon U, et al. The role of ECG-gated MDCT in the evaluation of aortic and mitral mechanical valves: initial experience. AJR Am J Roentgenol 2008;191:26-31 https://doi.org/10.2214/AJR.07.2951
  5. Lee DH, Youn HJ, Shim SB, Lee SH, Jung JI, Jung SE, et al. The measurement of opening angle and orifice area of a bileaflet mechanical valve using multidetector computed tomography. Korean Circ J 2009;39:157-162 https://doi.org/10.4070/kcj.2009.39.4.157
  6. Suchá D, Symersky P, Vonken EJ, Provoost E, Chamuleau SA, Budde RP. Multidetector-row computed tomography allows accurate measurement of mechanical prosthetic heart valve leaflet closing angles compared with fluoroscopy. J Comput Assist Tomogr 2014;38:451-456 https://doi.org/10.1097/RCT.0b013e3182ab5f15
  7. Tsai IC, Lin YK, Chang Y, Fu YC, Wang CC, Hsieh SR, et al. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol 2009;19:857-867 https://doi.org/10.1007/s00330-008-1232-2
  8. Teshima H, Hayashida N, Fukunaga S, Tayama E, Kawara T, Aoyagi S, et al. Usefulness of a multidetector-row computed tomography scanner for detecting pannus formation. Ann Thorac Surg 2004;77:523-526 https://doi.org/10.1016/S0003-4975(03)01531-5
  9. Ueda T, Teshima H, Fukunaga S, Aoyagi S, Tanaka H. Evaluation of prosthetic valve obstruction on electrocardiographically gated multidetector-row computed tomography--identification of subprosthetic pannus in the aortic position. Circ J 2013;77:418-423 https://doi.org/10.1253/circj.CJ-12-0290
  10. Park YJ, Kim YJ, Lee JW, Kim HY, Hong YJ, Lee HJ, et al. Automatic Tube Potential Selection with Tube Current Modulation (APSCM) in coronary CT angiography: Comparison of image quality and radiation dose with conventional body mass index-based protocol. J Cardiovasc Comput Tomogr 2012;6:184-190 https://doi.org/10.1016/j.jcct.2012.04.002
  11. Suh YJ, Kim YJ, Hong SR, Hong YJ, Lee HJ, Hur J, et al. Combined use of automatic tube potential selection with tube current modulation and iterative reconstruction technique in coronary CT angiography. Radiology 2013;269:722-729 https://doi.org/10.1148/radiol.13130408
  12. Symersky P, Budde RP, de Mol BA, Prokop M. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol 2009;104:1128-1134 https://doi.org/10.1016/j.amjcard.2009.05.061
  13. Aoyagi S, Arinaga K, Fukunaga S, Tayama E, Kosuga T, Akashi H. Leaflet movement of the ATS valve in the aortic position: unique behavior observed in 19-mm valves. Ann Thorac Surg 2006;82:853-857 https://doi.org/10.1016/j.athoracsur.2006.04.088
  14. Feng Z, Nakamura T, Fujimoto T, Umezu M. In vitro investigation of opening behavior and hydrodynamics of bileaflet valves in the mitral position. Artif Organs 2002;26:32-39 https://doi.org/10.1046/j.1525-1594.2002.06833.x
  15. Parnell A, Swanevelder J. High transvalvular pressure gradients on intraoperative transesophageal echocardiography after aortic valve replacement: what does it mean? HSR Proc Intensive Care Cardiovasc Anesth 2009;1:7-18
  16. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009;22:975-1014; quiz 1082-1084 https://doi.org/10.1016/j.echo.2009.07.013
  17. Tayama E, Feng Z, Oda T, Tomoeda H, Hayashida N, Fukunaga S, et al. ATS prosthetic valve motion: an in vitro analysis. J Heart Valve Dis 2000;9:408-414
  18. Habets J, Mali WP, Budde RP. Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics 2012;32:1893-1905 https://doi.org/10.1148/rg.327125702
  19. Habets J, Budde RP, Symersky P, van den Brink RB, de Mol BA, Mali WP, et al. Diagnostic evaluation of left-sided prosthetic heart valve dysfunction. Nat Rev Cardiol 2011;8:466-478 https://doi.org/10.1038/nrcardio.2011.71
  20. Montorsi P, Arena V, Muratori M, Lavarra F, Cavoretto D, Repossini A, et al. Fluoroscopic functional evaluation of bileaflet prostheses: effect of different intraoperative valve orientation. Am J Card Imaging 1996;10:101-107
  21. Cianciulli TE, Lax JA, Beck MA, Cerruti FE, Gigena GE, Saccheri MC, et al. Cinefluoroscopic assessment of mechanical disc prostheses: its value as a complementary method to echocardiography. J Heart Valve Dis 2005;14:664-673
  22. Cianciulli TF, Saccheri MC, Lax JA, Guidoin R, Zhang Z, Guerra JE, et al. Intermittent acute aortic regurgitation of a mechanical bileaflet aortic valve prosthesis: diagnosis and clinical implications. Eur J Echocardiogr 2009;10:446-449 https://doi.org/10.1093/ejechocard/jen320
  23. Kuniyoshi Y, Koja K, Miyagi K, Shimoji M, Uezu T, Arakaki K, et al. Pannus formation in aortic valve prostheses in the late postoperative period. J Artif Organs 2003;6:179-182 https://doi.org/10.1007/s10047-003-0226-8
  24. Teshima H, Hayashida N, Yano H, Nishimi M, Tayama E, Fukunaga S, et al. Obstruction of St Jude Medical valves in the aortic position: histology and immunohistochemistry of pannus. J Thorac Cardiovasc Surg 2003;126:401-407 https://doi.org/10.1016/S0022-5223(03)00702-5

Cited by

  1. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography vol.17, pp.4, 2015, https://doi.org/10.3348/kjr.2016.17.4.463
  2. Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction vol.3, pp.2, 2015, https://doi.org/10.1136/openhrt-2016-000494
  3. Absolute-Delay Multiphase Reconstruction Reduces Prosthetic Valve–Related and Atrial Fibrillation–Related Artifacts at Cardiac CT vol.208, pp.5, 2015, https://doi.org/10.2214/ajr.16.16839
  4. A Review of the Use of Cardiac Computed Tomography for Evaluating the Mitral Valve before and after Mitral Valve Repair vol.18, pp.5, 2015, https://doi.org/10.3348/kjr.2017.18.5.773
  5. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  6. Impact of pannus formation on hemodynamic dysfunction of prosthetic aortic valve: pannus extent and its relationship to prosthetic valve motion and degree of stenosis vol.107, pp.7, 2018, https://doi.org/10.1007/s00392-018-1217-3
  7. Experimental investigation of the flow downstream of a dysfunctional bileaflet mechanical aortic valve vol.43, pp.10, 2015, https://doi.org/10.1111/aor.13483
  8. Current Therapeutic Options in Aortic Stenosis vol.128, pp.9, 2021, https://doi.org/10.1161/circresaha.121.318040