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The Role of ECG-Gated MDCT in the Evaluation of Aortic and Mitral Mechanical Valves: Initial Experience

¹ Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
² Heart Institute, Sheba Medical Center, Ramat Gan, Israel.
³ Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —32-year-old man with normal functioning bileaflet aortic valve (patient 16 in Table 1). Multiplanar reformation images perpendicular to leaflets' axis enable measurement of closing (A) and opening (B) angles during diastole and systole, respectively.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —32-year-old man with normal functioning bileaflet aortic valve (patient 16 in Table 1). Multiplanar reformation images perpendicular to leaflets' axis enable measurement of closing (A) and opening (B) angles during diastole and systole, respectively.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —77-year-old man with normal functioning single-leaflet aortic mechanical valve (patient 18 in Table 1). Multiplanar reformation images perpendicular to leaflet's axis enable measurements of closing (A) and opening (B) angles during diastole and systole, respectively.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —77-year-old man with normal functioning single-leaflet aortic mechanical valve (patient 18 in Table 1). Multiplanar reformation images perpendicular to leaflet's axis enable measurements of closing (A) and opening (B) angles during diastole and systole, respectively.

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Bland-Altman plot shows agreement between measurements of bileaflet mechanical valve opening angles obtained by fluoroscopy and MDCT. Solid line shows mean difference, and dotted lines show mean difference ± 1.96 times SD of differences.

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Bland-Altman plot shows agreement between measurements of bileaflet mechanical valve closing angles obtained by fluoroscopy and MDCT. Solid line shows mean difference, and dotted lines show mean difference ± 1.96 times SD of differences.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5F —66-year-old man with stuck mitral bileaflet mechanical valve (patient 2 in Table 1). Multiplanar reformation images (A and B) and volume-rendering reformations (C and D) during diastole (A and C) and during systole (B and D) and corresponding fluoroscopic images (E and F) show stuck leaflet (white arrow, A). Note soft-tissue attenuation on ventricular border (black arrow, A) of stuck valve, which is suggestive of pannus.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —67-year-old man with normal functioning bileaflet aortic valve and perivalvular leak (patient 8 in Table 1). Multiplanar reformation images in three perpendicular planes on systole (A) and diastole (B) show normal functioning valve with anterior dehiscence (arrows) causing aortic regurgitation. Ao = aorta, LV = left ventricle.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —67-year-old man with normal functioning bileaflet aortic valve and perivalvular leak (patient 8 in Table 1). Multiplanar reformation images in three perpendicular planes on systole (A) and diastole (B) show normal functioning valve with anterior dehiscence (arrows) causing aortic regurgitation. Ao = aorta, LV = left ventricle.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —67-year-old man with normal functioning bileaflet aortic valve and perivalvular leak (patient 8 in Table 1). Corresponding superior views of volume-rendering reformation above aortic valve (solid arrows) show clearly perivalvular leak (open arrows). LA = left atrium, RA = right atrium, RVOT = right ventricular outflow tract.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —67-year-old man with normal functioning bileaflet aortic valve and perivalvular leak (patient 8 in Table 1). Corresponding superior views of volume-rendering reformation above aortic valve (solid arrows) show clearly perivalvular leak (open arrows). LA = left atrium, RA = right atrium, RVOT = right ventricular outflow tract.

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