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  • Review Article
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Diagnostic evaluation of left-sided prosthetic heart valve dysfunction

Nature Reviews Cardiology volume 8, pages 466–478 (2011)Cite this article

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Abstract

Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these techniques sometimes fail to determine the specific cause of PHV dysfunction, which is crucial to the selection of the appropriate treatment strategy. Multidetector-row CT (MDCT) can be of additional value in diagnosing the specific cause of PHV dysfunction and provides valuable complimentary information for surgical planning in case of reoperation. Cardiac magnetic resonance imaging (CMR) has limited value in the evaluation of biological PHV dysfunction. In this Review, we discuss the use of established imaging modalities for the detection of left-sided mechanical and biological PHV dysfunction and discuss the complementary role of MDCT in this context.

Key Points

  • Echocardiography and fluoroscopy are the 'gold standard' for the evaluation of mechanical prosthetic heart valve (PHV) dysfunction

  • Echocardiography is the preferred imaging technique to assess biological PHV dysfunction.

  • Determining the exact cause of PHV dysfunction is essential for optimal patient treatment, but echocardiography and fluoroscopy sometimes fail to identify the exact cause of the PHV dysfunction

  • Multislice CT can complement echocardiography and fluoroscopy particularly in patients with mechanical heart valve obstruction and infective PHV endocarditis

  • Multislice CT can provide specific anatomical information assisting the cardiothoracic surgeon during the planning of reoperation

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Figure 1: Assessment of PHV dysfunction with TEE.
Figure 2: CT images of a thrombosed Carbomedics® (Sorin Group USA Inc., Arvada, CO, USA) bileaflet prosthetic heart valve in the aortic position.
Figure 3: CT image of a Carbomedics® (Sorin Group USA Inc., Arvada, CO, USA) prosthetic bileaflet heart valve in the aortic position with pannus formation.
Figure 4: Flowchart for suggested noninvasive imaging protocol in the diagnostic work-up of patients with suspected PHV dysfunction.
Figure 5: Transesophageal echocardiography of mechanical bileaflet prosthetic heart valves.
Figure 6: MDCT images of a Carbomedics® (Sorin Group USA Inc., Arvada, CO, USA) valve in a patient with infective endocarditis.

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Acknowledgements

We thank K. A. Rijnbach (Department of Radiology, University Medical Center Utrecht) for her help with the final editing of the Figures and I. G. Janssen (Department of Multimedia Productions, University Medical Center Utrecht) for designing Figure 1b. This work was supported by a grant of the Netherlands Heart Foundation (grant number 2009B014).

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Authors and Affiliations

  1. Department of Radiology, University Medical Center, P. O. Box 85500, Utrecht, 3508, GA, The Netherlands

    Jesse Habets, Ricardo P. Budde & Willem P. Mali

  2. Department of Cardiothoracic Surgery, University Medical Center, P. O. Box 85500, Utrecht, 3508, GA, The Netherlands

    Lex A. van Herwerden

  3. Department of Cardiology, University Medical Center, P. O. Box 85500, Utrecht, 3508, GA, The Netherlands

    Steven A. Chamuleau

  4. Department of Cardiology, Academic Medical Center, P. O. Box 22660, Amsterdam, 1100, DD, The Netherlands

    Renee B. van den Brink

  5. Department of Cardiothoracic Surgery, Academic Medical Center, P. O. Box 22660, Amsterdam, 1100, DD, The Netherlands

    Petr Symersky & Bas A. de Mol

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Habets, J., Budde, R., Symersky, P. et al. Diagnostic evaluation of left-sided prosthetic heart valve dysfunction. Nat Rev Cardiol 8, 466–478 (2011). https://doi.org/10.1038/nrcardio.2011.71

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