Sinus of Valsalva Thrombosis Detected on Computed Tomography after Transcatheter Aortic Valve Replacement
Korean Circulation Journal 2020³â 50±Ç 7È£ p.572 ~ p.582
ÀÓ¼öÁø(Lim Su-Jin) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
±¸ÇöÁ¤(Koo Hyun-Jung) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
Á¤½Âä(Jung Seung-Chai) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
°µµÀ±(Kang Do-Yoon) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
¾ÈÁ¤¹Î(Ahn Jung-Min) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
¹Ú´ö¿ì(Park Duk-Woo) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
¹Ú½ÂÁß(Park Seung-Jung) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
¾çµ¿Çö(Yang Dong-Hyun) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
°ÁØ¿ø(Kang Joon-Won) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
Abstract
Background and Objectives: Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis.
Methods: Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated.
Results: The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants.
Conclusions: Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.
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Aortic valve stenosis, Multidetector computed tomography, Transcatheter aortic valve replacement, Thrombosis, Sinus of valsalva
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À¯È¿¼º°á°ú(Recomendation)
Cardiac CT after TAVR can detect sinus of Valsalva thrombosis; sinus of Valsalva thrombosis is uncommon but can be detected on post-TAVR CT scans.