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Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected
Amr Youssef Hassan1, Hussien Heshmat Kassem1, Hossam Ibrahim Kandil1
1Cardiovascular Medicine Department, Cairo University, Cairo, Egypt.
Insights
Routine cardiac computed tomography angiography (CCTA) complements transesophageal echocardiography (TEE) for prosthetic valve dysfunction (PVD). CCTA improves diagnosis of periannual complications and guides treatment decisions in PVD patients.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Prosthetic Valve Technology
Background:
- Computed Tomography (CT) is valuable for assessing coronary arteries and great vessels.
- Routine use of CT for suspected prosthetic valve dysfunction (PVD) lacks thorough investigation.
Purpose of the Study:
- To evaluate the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD.
Main Methods:
- Prospective cohort study of 50 consecutive patients with suspected PVD.
- Patients underwent 64-slice ECG-gated CT and transesophageal echocardiography (TEE).
- Intraoperative findings served as the gold standard.
Main Results:
- ECG-gated CT revealed findings missed by TEE in 32% of patients, including aortic root abscess, pseudoaneurysm, and paravalvular leakage.
- CTA findings influenced treatment changes in 28% of patients.
- Specific findings included suture disruption, occluder malfunction, thrombus, and aortic dissection.
Conclusions:
- ECG-gated CTA plays a complementary role to TEE in suspected PVD.
- CCTA excels in diagnosing periannular complications and defining their anatomical relationships.
- CCTA aids in planning corrective procedures (surgical or percutaneous) for PVD.
Introduction:
Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly.
Objective:
To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD.
Methods And Results:
This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%).
Conclusion:
This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
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