Subprosthetic Pannus after Aortic Valve Replacement Surgery: Cardiac CT Findings and Clinical Features.

Han, Kichang; Yang, Dong Hyun; Shin, So Youn; Kim, Namkug; Kang, Joon-Won; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Lim, Tae-Hwan
2015Sep ; 276 ( 3 ) :724-31.
저자 상세정보
Han, Kichang -
Yang, Dong Hyun -
Shin, So Youn -
Kim, Namkug -
Kang, Joon-Won -
Kim, Dae-Hee -
Song, Jong-Min -
Kang, Duk-Hyun -
Song, Jae-Kwan -
Kim, Joon Bum -
Jung, Sung-Ho -
Choo, Suk Jung -
Chung, Cheol Hyun -
Lee, Jae Won -
Lim, Tae-Hwan -
PURPOSE: To investigate the cardiac computed tomographic (CT) findings and clinical implications of subprosthetic pannus in patients who have undergone aortic valve replacement. MATERIALS AND

METHODS: The institutional review board approved this retrospective study, and the need to obtain written informed consent was waived. From April 2011 to March 2012, 88 patients (mean age, 63 years; 45 men) with a prosthetic aortic valve who underwent cardiac CT were retrospectively selected. Dynamic cardiac CT images were analyzed by using a multiplanar reformatted technique. The presence or absence of subprosthetic pannus and its extent were evaluated at cardiac CT. The geometric orifice area and the effective orifice area of each prosthetic valve were measured to enable analysis of the pannus encroachment ratio in the systolic phase. Hemodynamic parameters at echocardiography, including mean transprosthetic pressure gradient (MTPG), were compared between patients with and those without pannus. The encroachment ratio and the MTPG were correlated by using the Spearman test to evaluate the relationship between the two variables.

RESULTS: Seventeen patients (19%) had subprosthetic pannus at cardiac CT. In patients with subprosthetic pannus, MTPG, peak pressure gradient, transvalvular peak velocity, and left ventricular ejection fraction (LVEF) were significantly higher than in patients without pannus (MTPG: 28.1 mm Hg 짹 19.8 [standard deviation] vs 14.0 mm Hg 짹 6.5, P = .004; peak pressure gradient: 53.1 mm Hg 짹 38.4 vs 26.1 mm Hg 짹 11.4, P = .004; transvalvular peak velocity: 3.3 m/sec 짹 1.3 vs 2.5 m/sec 짹 0.5; and LVEF: 64.7% 짹 7.4 vs 56.8% 짹 10.5, P = .004). A high MTPG (??0 mm Hg) was observed in four patients at echocardiography, and subprosthetic panni were identified at CT in all four patients. In patients with increased MTPGs, the encroachment ratio by subprosthetic pannus at CT was significantly higher than that in patients with MTPGs of less than 40 mm Hg (42.7 짹 13.3 vs 7.6 짹 3, P = .012). CONCLUSION: Cardiac CT revealed subprosthetic pannus to be a cause of the hemodynamic changes in patients who had undergone aortic valve replacement. By helping quantify the encroachment ratio by pannus, cardiac CT may help differentiate which subprosthetic panni might lead to substantial flow limitation over the prosthetic aortic valve.
Adult, Aged, Aged, 80 and over, Aortic Valve/*surgery, *Cardiac Imaging Techniques, Female, Heart Diseases/diagnosis/*etiology/*radiography, Heart Valve Prosthesis Implantation/*adverse effects, Humans, Male, Middle Aged, Retrospective Studies, *Tomography, X-Ray Computed

주제명(Target field)
연구참여(Sample size)
질병특성(Condition Category)
연구설계(Study Design)
중재방법(Intervention Type)
중재명칭(Intervention Name)
Cardiac CT revealed subprosthetic pannus to be a cause of the hemodynamic changes in patients who had undergone aortic valve replacement.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
ICD 03