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Usefulness of cardiac CT scan in patients with undetermined aortic prosthesis dysfunction
Session:
Painel 10 - Doença Valvular 4
Speaker:
Maria Luísa Malvar Azevedo Magalhães Gonçalves
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Maria Luisa Gonçalves; Hugo Da Silva Antunes; Inês Pires; João Miguel Santos; Joana Laranjeira Correia; Wilson Ferreira; Mónica Teixeira; Nuno Dias Ferreira; Ricardo Ladeiras Lopes; Rita Faria
Abstract
<p><strong><u>Introduction</u></strong>: Prosthetic aortic valve dysfunction (PAVD) by obstruction (O) is a serious complication. Echocardiography (E) and fluoroscopy (F) are common diagnostic methods, but sometimes the cause of O is unclear. Cardiac CT emerges as an alternative diagnostic method, that can identify the etiology of O that is missed at E and F with consequent alteration of the therapeutic strategy.</p> <p><strong><u>Objective</u></strong>: Evaluate the diagnostic profitability of cardiac CT in the etiological research of (PAVD) by O and its impact on therapeutic strategy and major clinical events.</p> <p><strong><u>Methods</u></strong>: Selected all patients that underwent a cardiac CT between 01/2017 and 11/2019 on suspicion of obstruction by high transprosthetic gradients in E and without previously defined cause. Excluded all patients with actual or previous history of infective endocarditis. CT multidetector <em>Siemens Somaton Force Dual Source</em> - 192 cuts, and <em>Siemens Somaton</em> - 64 cuts, were used, with retrospective ECG acquisition. Clinically significant events during follow-up: heart failure (HF) admission, reoperation or death. Division in 2 groups: with etiological cause identified with cardiac CT (group A) vs without (group B).</p> <p><strong><u>Results</u></strong>: 17 patients were selected accordingly with the study criteria. 52.9% (n=9) female. Mean age 65.5 +/- 13.9 years. 70.6% mechanical (33.3% tilting disk and 66.6% bidisc), 11.8% bioprosthetic and 17.6% transcutaneous aortic valve implantation. Median time from valve surgery to dysfunction suspicion of 7.4 [0.25-39.2] years (mechanical 12.75 [5.42-39.32] years and bioprosthetic 3.83 [6.5-0.25] years).</p> <p>Technical aspects: median kilovoltage 100mV [80-120], contrast 65mL [50-120], miliamperage de 263 mAs [206-648], heart rate 71bpm [45-101], all in sinus rhythm, and equivalent dose radiation 7.4 mSv [3.5-17.1].</p> <p>Group B in 41.2% (n= 7) and group A in 58.8% (n=10): with 29.4% (n=5) patients with pannus and 17.4% (n=3) with thrombus and 11.8% (n=2) with degenerative valve alterations. No differences in technical aspects, clinical presentation, transprosthesis gradients or orifice prosthesis area by E.</p> <p>Group B was composed with smaller patients (138.14 vs 163.60 cm, p=0.046), but no difference in body surface area (1.53 vs 1.78, p>0.05). There was a good correlation (r=0.76, p=0.018) between evidence of alteration in opening and closing angles in F and CT, in mechanical prosthesis.</p> <p>No patient died in the follow-up. There was a statistically association between the Group A and the occurrence of the composed endpoint (70% vs 14.3%, X<sup>2</sup> = 5.1, p=0.024), with a median time to event of 3 [0-9] months. Group A had an odds ratio in favor of a clinical event about 2.63 times greater than group B [95% CI: 1.01 – 6.86, p=0.039].</p> <p><strong><u>Conclusion</u></strong>: Cardiac CT identified the cause of PAVD in 60% of the patients, that correlated with clinical events. Although a small population, this study confirms the additional valor of cardiac CT in PAVD with unknown cause.</p>
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