Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Extent of Subprosthetic Pannus after Aortic Valve Replacement: Changes Over Time and Relationship with Echocardiographic Findings

대동맥판막치환술 후 발생한 판막하 판누스(Pannus): 시간에 따른 변화 및 심초음파 소견

  • Mi Yeon Park (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center) ;
  • Hyun Jung Koo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center) ;
  • Hojin Ha (Department of Mechanical and Biomedical Engineering, Kangwon National University) ;
  • Joon-Won Kang (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center) ;
  • Dong Hyun Yang (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Cardiac Imaging Center, Asan Medical Center)
  • 박미연 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 구현정 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 하호진 (강원대학교 기계의용공학과) ;
  • 강준원 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 양동현 (울산대학교 의과대학 서울아산병원 영상의학과)
  • Received : 2019.06.25
  • Accepted : 2019.10.18
  • Published : 2020.09.01
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Abstract

Purpose This study aimed to evaluate changes of subprosthetic pannus on cardiac CT and determine its relationship to echocardiographic findings in patients with mechanical aortic valve replacement (AVR). Materials and Methods Between April 2011 and November 2017, 17 AVR patients (56.8 ± 8.9 years, 12% male) who showed pannus formation on CT and had undergone both follow-up CT and echocardiography were included. The mean interval from AVR to the date of pannus detection was 10.5 ± 7.1 years. In the initial and follow-up CT and echocardiography, the pannus extent and echocardiographic parameters were compared using paired t-tests. The relationship between the opening angle of the prosthetic valve and the pannus extent was evaluated using Pearson correlation analysis. Results The pannus extent was significantly increased on CT (p < 0.05). The peak velocity (3.9 ± 0.8 m/s vs. 4.2 ± 0.8 m/s, p = 0.03) and mean pressure gradient (36.4 ± 15.5 mm Hg vs. 42.1 ± 15.8 mm Hg, p = 0.03) were significantly increased. The mean opening angles of the mechanical aortic leaflets were slightly decreased, but there was no statistical significance (73.1 ± 8.3° vs. 69.4 ± 12.1°, p = 0.12). The opening angle of the prosthetic leaflets was inversely correlated with the pannus extent (r = -0.57, p < 0.001). Conclusion The pannus extent increases over time, increasing transvalvular peak velocity and the pressure gradient. CT can be used to evaluate the pannus extent associated with hemodynamic changes that need to be managed by surgical intervention.

목적 본 후향적 연구는 심장 CT를 이용하여 대동맥판막치환술 후 발생한 판누스(pannus)가 시간 경과에 따라 증가하는지를 평가하고 심초음파 결과와 비교하는 것을 목적으로 한다. 대상과 방법 2011년 4월부터 2017년 11월까지 CT에서 판누스가 발견되어 follow-up 심장 CT와 심초음파를 촬영한 17명의 환자를 포함하였다. 대동맥판막치환술 후 판누스 발견까지의 시간은 평균 10.5 ± 7.1년이었다. 처음 판누스가 발견된 CT와 이후 CT에서 판누스의 변화를 확인하고, 심초음파 결과의 변화를 paired t-test를 이용하여 분석하였다. 인공판막의 열리는 정도와 판누스의 크기는 Pearson 상관관계분석을 이용하여 평가하였다. 결과 판누스의 크기는 follow-up CT에서 증가하였다(p < 0.05). 대동맥판막을 지나는 최고 혈류속도(3.9 ± 0.8 m/s vs. 4.2 ± 0.8 m/s, p = 0.03)와 평균 압력차(36.4 ± 15.5 mm Hg vs. 42.1 ± 15.8 mm Hg, p = 0.03)는 심초음파상 의미 있게 증가하였다. 인공판막의 열리는 정도는 약간 감소하였으나 의미 있는 변화는 아니었다(73.1 ± 8.3° vs. 69.4 ± 12.1°, p = 0.12). 인공판막의 열리는 정도와 판누스의 크기는 음의 상관관계를 보였다(r = -0.57, p < 0.001). 결론 판누스는 시간이 지남에 따라 커졌고, 이에 따라 인공판막을 지나는 혈류속도와 평균 압력차가 증가하였다. 심장 CT는 판누스의 크기를 평가할 수 있고, 이는 혈역학적 변화와 관련이 있으며 추후 수술 여부 결정에 도움을 줄 수 있다.

Keywords

References

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