Usefulness of cardiac computed tomography in prosthetic heart valve dysfunction.

BACKGROUND: Prosthetic heart valve (PHV) dysfunction is a serious complication. Echocardiography remains the first-line imaging investigation to assess PHV dysfunction. However, the role of Computed Tomography (CT) scanning in this type of case has not been thoroughly studied yet. The objective of our study was to determine if cardiac Computed Tomography (CT) had a potentially complementary role to play alongside echocardiography in diagnosing the mechanism of prosthetic valve dysfunction. METHODS AND RESULTS: This prospective cohort study was conducted on 54 patients with suspected PHV dysfunction. All patients underwent routine diagnosis work-up (transthoracic and transesophageal echocardiography) and additional cardiac CT. Cardiac CT showed findings that were not detected by echocardiography in seven patients (12%) namely aortic pannus (5) and pseudoaneurysm (2). An underlying thrombus was detected by echocardiography and missed by cardiac CT in 15 patients (27%). However, in these thrombotic cases, cardiac CT contributed to the functional evaluation of leaflets. CONCLUSION: This study demonstrates that an integrated approach including transthoracic, transesophageal echocardiography and computed tomography is useful in patients with suspected PHV dysfunction. While computed tomography is more accurate in the diagnosis of pannus formation and periannular complications, echocardiography is superior at detecting thrombus.

A giant calcified aneurysm of the basal inferior wall: a rare phenomenon.

Left ventricular aneurysms (LVA) are mainly a late consequence of transmural myocardial infarction. Approximately 80% of LVA are located in the anterior and/or apical walls, most commonly associated with left anterior descending artery occlusion but any region may be engaged. Basal inferior wall aneurysms are rare and constitute nearly 3% of all LVA. A calcified LVA is seldom observed in modern clinical practice. And a calcified basal inferior LVA is an even rarer coincidence. We report a case of an 82-year-old women with life threatening arrhythmia revealing a giant calcified aneurysm of the basal inferior wall, medically treated with good outcomes. The exact incidence of left ventricular aneurysms (LVA) following myocardial infarctions is hard to precise but it is clearly decreasing. Eighty percent (80%) of LVA are located in the anterior or apical walls, but any region may be engaged. Basal inferior wall aneurysms constitute 3% of all LVA. Echocardiography is the first diagnostic tool and there is still no clear guidelines on how to treat LVAs. Surgery is preferred but medical treatment may help improve the quality of life.