Complementary role of cardiac computed tomography to transesophageal echocardiography in the evaluation of prosthetic valve dysfunction

Correspondence

Complementary role of cardiac computed tomography to

transesophageal echocardiography in the evaluation of prosthetic

valve dysfunction☆

,

_☆☆

Macit Kalç

ık

⁎

, Sabahattin Gündüz

, Mustafa Ozan Gürsoy

, Mehmet Özkan

a

Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum,Turkey

b

Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey

c

Department of Cardiology, Gaziemir State Hospital,İzmir, Turkey

d

Division of Health Sciences, Ardahan University, Ardahan, Turkey

a r t i c l e i n f o

Cardiac computed tomography Transesophageal echocardiography

Dear Editor,

We have read with great interest the article by Suh et al. describing the added value of cardiac computed tomography (CT) in the evaluation of pannus overgrowth on mechanical prosthetic valves[1]. Cardiac CT has a complementary role to transesophageal echocardiography and be-come an emerging diagnostic tool in the evaluation of mechanical pros-thetic valves[2,3].

Attenuation values of the abnormal masses adjacent to the prosthet-ic valves may provide quantitative data for the differentiation of pannus and thrombus formation. Pannus is excessive overgrowth offibroblastic tissue together with in_{flammatory cells and calcifications, whereas} thrombus is afibrin mass in which erythrocytes, platelets, and leuko-cytes are enmeshed[4]. Based on the histopathologic differences be-tween pannus and thrombus, x-ray attenuation of pannus must be markedly higher than that of thrombus.

Suh et al. compared the attenuation of the masses with the attenua-tion of interventricular septum to differentiate pannus or thrombus. We have recently described a quantitative approach to distinguish pannus

and thrombus by cardiac CT[5]. Periprosthetic masses with Hounsfield Unit (HU)≥145 was associated with the presence of pannus formation with high sensitivity and specificity, whereas a lower value was associ-ated with thrombus formation. Furthermore, masses with HUb90 were almost always completely lysable with thrombolytic therapy.

Despite the limitations of streak artifacts and volume averaging, car-diac CT has an incremental value in identification and characterization of periprosthetic masses and guides the treatment of patients with pros-thetic valve dysfunction.

Funding

No funding.

Con_{flict of interest}

All of the authors have no conflict of interest. References

[1] Y.J. Suh, S. Lee, D.J. Im, S. Chang, Y.J. Hong, H.J. Lee, J. Hur, B.W. Choi, B.C. Chang, C.Y. Shim, G.R. Hong, Y.J. Kim, Added value of cardiac computed tomography for evalua-tion of mechanical aortic valve: emphasis on evaluaevalua-tion of pannus with surgical find-ings as standard reference, Int. J. Cardiol. 214 (Jul 1 2016) 454–460.

[2] S. Gündüz, M. Ozkan, M. Biteker, T. Güneysu, Imaging of the mechanical heart valve pannus formation with multidetector computerised tomography, Eur. J. Cardiothorac. Surg. 37 (2010) 1472.

[3] S. Gündüz, M. Ozkan, M. Biteker, T. Güneysu, Mechanical mitral valve thrombosis and giant left atrial thrombus: comparison of transesophageal echocardiography and 64-slice multidetector computed tomography, Turk Kardiyol. Dern. Ars. 37 (2009) 483–487.

[4] N. Vitale, A. Renzulli, L. Agozzino, A. Pollice, N. Tedesco, L. de Luca Tupputi Schinosa, M. Cotrufo, Obstruction of mechanical mitral prostheses: analysis of pathologic find-ings, Ann. Thorac. Surg. 63 (1997) 1101–1106.

[5] S. Gündüz, M. Özkan, M. Kalçik, O.M. Gürsoy, M.A. Astarcioğlu, S. Karakoyun, A.Ç. Aykan, M. Biteker, T. Gökdeniz, H. Kaya, M. Yesin, N.E. Duran, D. Sevinç, T. Güneysu, Sixty-four-section cardiac computed tomography in mechanical prosthetic heart valve dysfunction: thrombus or pannus, Circ. Cardiovasc. Imaging 8 (2015), e003246. .

International Journal of Cardiology 239 (2017) 1

☆ Data sharing: No additional data.

☆☆ Contributorship: All of the authors contributed planning, conduct, and reporting of the work. All contributors are responsible for the overall content as guarantors.

⁎ Corresponding author at: Hitit University Çorum Training and Research Hospital, Yeniyol, Çamlık Cad. No: 2, Çorum, Turkey.

E-mail address:[email protected](M. Kalçık).

http://dx.doi.org/10.1016/j.ijcard.2017.03.030

0167-5273/© 2017 Elsevier B.V. All rights reserved.

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