Related Experiment Video

Updated: Dec 18, 2025

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
06:59

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

Published on: June 3, 2018

10.9K

Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Valves: PARTNER 3 Cardiac Computed

Raj R Makkar1, Philipp Blanke2, Jonathon Leipsic2

  • 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Journal of the American College of Cardiology
|June 20, 2020
PubMed

Insights

Subclinical leaflet thrombosis (HALT) was more common in transcatheter aortic valves initially but not at one year. Persistent HALT may increase transcatheter aortic valve gradients over time.

Area of Science:

  • Cardiology
  • Radiology
  • Biomedical Engineering

Background:

  • Subclinical leaflet thrombosis, identified as hypoattenuated leaflet thickening (HALT) and reduced leaflet motion on 4D CT, is a potential form of bioprosthetic valve dysfunction.
  • The FDA mandated CT imaging to investigate HALT's natural history, differences between transcatheter aortic valve replacement (TAVR) and surgical valves, and its clinical implications.

Purpose of the Study:

  • To assess the incidence and natural history of HALT in patients undergoing TAVR versus surgical aortic valve replacement (SAVR).
  • To evaluate the association between HALT and valve hemodynamics and clinical outcomes.

Main Methods:

  • The PARTNER 3 CT substudy randomized 435 low-risk patients with aortic stenosis to TAVR or SAVR.
  • Serial 4D CT scans were performed at 30 days and 1 year post-procedure and analyzed by a core laboratory.

Main Results:

  • HALT incidence increased from 10% at 30 days to 24% at 1 year. Spontaneous HALT resolution occurred in 54% of cases, while new HALT emerged in 21% at 1 year.
  • HALT was more frequent in TAVR vs. SAVR at 30 days (13% vs. 5%), but not at 1 year (28% vs. 20%).
  • Persistent HALT at both 30 days and 1 year was associated with significantly increased aortic valve gradients at 1 year.

Conclusions:

  • Subclinical leaflet thrombosis was more frequent in TAVR compared to SAVR at 30 days, but this difference diminished at 1 year.
  • The long-term impact of HALT on thromboembolic events and structural valve degeneration requires further investigation.
Abstract

Keywords:
hypoattenuated leaflet thickeningleaflet thrombosisreduced leaflet motionsubclinical leaflet thrombosis

More Related Videos

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement09:57

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

Published on: January 20, 2022

3.0K
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair08:31

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

4.3K

Related Concept Videos

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
204
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
161
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
131
Cardiac Catheterization III: Left Heart Catheterization01:24

Cardiac Catheterization III: Left Heart Catheterization

Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
429
Imaging Studies for Cardiovascular System V: CT01:28

Imaging Studies for Cardiovascular System V: CT

Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
182
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
135