Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features

• Published in: European heart journal cardiovascular imaging 2018-12, Vol.19 (12), p.1419-1427
• Main Authors: Koo, Hyun Jung, Lee, Joo Yeon, Kim, Gun Ha, Kang, Joon-Won, Kim, Young-Hak, Kim, Dae-Hee, Song, Jong-Min, Kang, Duk-Hyun, Song, Jae-Kwan, Lim, Tae-Hwan, Yang, Dong Hyun
• Format: Article
• Language: English
• Subjects: Aged; Anastomotic Leak - diagnostic imaging; Anastomotic Leak - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiac Imaging Techniques - methods; Cohort Studies; Echocardiography, Three-Dimensional - methods; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Observer Variation; Prognosis; Prosthesis Failure; Reoperation - methods; Retrospective Studies; Risk Assessment; Survival Rate; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jex341

Morphological characteristics of paravalvular leakage (PVL) have not yet been well characterized by computed tomography (CT). The purpose of this study was to demonstrate the morphological characteristics of PVLs using cardiac CT in patients diagnosed with PVL. Between May 2011 and December 2013, 46 patients who had been diagnosed with PVL and underwent cardiac CT were included in this study. On CT, the characteristics of PVLs including number, size, location, and shape are described. Inter- and intra-observer agreement of CT were assessed. The extent of PVL on CT and the degree of regurgitant grade on echocardiography are compared. The size of PVLs were compared between patients who underwent surgical correction and who treated with percutaneous device closure or observed without treatment. All PVLs detected on surgical filed were the same with the number and locations of PVLs demonstrated on CT. Interobserver agreement for CT measurements of the PVL was good, ranging from 0.78 to 0.99. The sizes of PVL were smaller in patients who treated with device closure or observed without treatment compared to those in patients who underwent surgical correction (median areas of aortic PVL, 64.5 vs. 15.5 mm2 and mitral PVL, 40.0 vs. 27.0 mm2). PVL sizes were larger in patients with higher regurgitant grades on echocardiography (P