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DOI:10.2214/AJR.08.2178
AJR 2009; 193:W389-W396
© American Roentgen Ray Society

Original Research

Evaluation of Mechanical Heart Valve Size and Function With ECG-Gated 64-MDCT

Troy M. LaBounty1, Prachi P. Agarwal2, Aamer Chughtai2, David S. Bach3, Eric Wizauer2 and Ella A. Kazerooni2

1 Department of Medicine, Division of Cardiology, Weill Cornell Medical College, 520 E 70th St., Starr Pavilion 4th Floor, New York, NY 10021.
2 Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health System, Ann Arbor, MI.
3 Department of Medicine, Division of Cardiovascular Medicine, University of Michigan Cardiovascular Center, Ann Arbor, MI.

OBJECTIVE. The purpose of our study was to determine whether CT can accurately evaluate mechanical heart valve size and function.

MATERIALS AND METHODS. Sixty-two patients with mechanical valves (37 single-disc, 27 bileaflet; 59 aortic, 5 mitral) were evaluated with ECG-gated 64-MDCT and transthoracic echocardiography; a subset of 10 patients underwent cinefluoroscopy. Two readers independently interpreted each study.

RESULTS. The mean age of the patients was 46.4 ± 14.4 years; 50 were men and 12 were women. There was excellent correlation, and differences between CT readers were absent to small in measuring the opening angle (r = 0.96, p < 0.001; 76.7 ± 9.0° vs 76.8 ± 9.6°, p = 0.73), annulus diameter (r = 0.96, p < 0.001; 25.9 ± 3.3 vs 25.9 ± 3.2 mm, p = 0.62), and geometric orifice area (r = 0.98, p < 0.001; 3.8 ± 0.9 vs 3.6 ± 0.8 cm2, p < 0.001). There was strong correlation without difference in opening angle between CT and cinefluoroscopy (r = 0.77, p < 0.001; 79.2° ± 9.8° vs 77.2° ± 15.5°, p = 0.45). Compared with manufacturer specifications, CT reported opening angles that were smaller for single-disc valves (n = 36, 67.4° ± 5.7° vs 75°, p < 0.001) and similar for bileaflet valves (n = 42 for 21 valves, 83.8° ± 3.9° vs 85°, p = 0.05), valves, with small underestimation with CT versus specifications in annulus diameter (n = 41; r = 0.75, p < 0.001; 26.4 ± 3.0 vs 27.5 ± 3.3 mm, p = 0.003), and geometric orifice area (n = 35; r = 0.90, p < 0.001; 3.7 ± 0.7 vs 3.8 ± 0.8 cm2, p = 0.04). Each disc closed fully on CT; none had more than mild regurgitation on echocardiography.

CONCLUSION. CT can measure the size and function of mechanical valves with high interobserver agreement and results similar to specifications. The opening angle with CT strongly correlates with cinefluoroscopy. CT is promising for the assessment of mechanical valves.

Keywords: cardiac CT • valvular heart disease


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