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We investigated the predictive value of preoperative computed tomography (CT)-derived tricuspid annular and right ventricular (RV) parameters for postoperative RV dysfunction in patients undergoing tricuspid valve (TV) surgery. We retrospectively reviewed clinical, transthoracic echocardiography (TTE), and CT data of 100 consecutive patients who underwent cardiac CT and subsequently received TV surgery. Preoperative cardiac CT and TTE parameters were analyzed, including TV annulus diameter and RV size. Univariate and multivariate logistic regression analyses were performed to identify significant predictors for postoperative RV dysfunction, both in the entire study population and in the subgroup of patients without preoperative RV dysfunction. Postoperative RV dysfunction occurred in 46% of all patients. In the multivariate logistic regression analysis, longer TV annulus diameter (>29.3 mm/m2 on four-chamber view; (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.13–11.24), larger RV volume (RV end-diastolic volume/body surface area > 128.8 ml/m2) on CT (OR 3.85, 95% CI 1.24–11.98) and presence of preoperative RV dysfunction on TTE (OR 11.96, 95% CI 2.8–50.99) were independent predictors for postoperative RV dysfunction in the entire study population (P < 0.05). Among patients without preoperative RV dysfunction, longer TV annulus diameter (OR 4.02, 95% CI 1.20–13.41) and larger RV volume on CT (OR 6.09, 95% CI 1.87–19.80) were independent predictors for postoperative RV dysfunction (P < 0.05). Preoperative assessment of cardiac CT imaging–based TV annular diameter and RV volume can provide independent information for predicting postoperative RV dysfunction in patients undergoing TV surgery. • Postoperative RV dysfunction occurred in 46% after tricuspid valve surgery. • Longer TV annulus diameter and larger RV volume on CT were predictors. • Predictive information from TV annulus diameter and RV volume on preoperative CT [ABSTRACT FROM AUTHOR]

Background The clinical significance of pannus in the prosthetic mitral valve (MV) is not well documented. Objectives To investigate the clinical significance of pannus on cardiac computed tomography (CT) in patients with a prosthetic MV. Methods A total of 130 patients with previous MV replacement who underwent cardiac CT were retrospectively included in this study. The presence of pannus, paravalvular leak (PVL) around the prosthetic MV and limitation of motion (LOM) of the MV were analyzed using CT. Between patients with MV pannus and those without pannus, CT, echocardiographic, and redo-surgery findings were compared. The diagnostic performance of CT and transesophageal echocardiography (TEE) for the detection of MV pannus was also compared, using surgical findings as a standard reference. Results MV pannus was observed on cardiac CT in 32.3% of the study population. Patients with MV pannus detected on CT more commonly had LOM (28.2% vs. 15.2%) and less frequently had PVL of the prosthetic MV (16.7% vs. 25%) than patients without MV pannus (P > 0.05). Prosthetic valve obstruction (PVO) due prosthetic MV pannus requiring redo-surgery was present in only five patients (11.9%). Cardiac CT detected MV pannus with sensitivity of 65.2% and specificity of 80.9% and showed better diagnostic performance than TEE (P < 0.05). Conclusions Prosthetic MV pannus can frequently be seen on cardiac CT. However, its clinical significance should be assessed with careful consideration, because PVO due to MV pannus is relatively uncommon, and pannus can be seen in patients without any clinical problems. [ABSTRACT FROM AUTHOR]

Background The added value of cardiac computed tomography (CT) with transesophageal echocardiography (TEE) for evaluating mechanical aortic valve (AV) dysfunction has not yet been investigated. The purposes of this study were to investigate the added value of cardiac CT for evaluation of mechanical AVs and diagnoses of pannus compared to TEE, with surgical findings of redo-aortic valve replacement (AVR) used as a standard reference. Methods 25 patients who underwent redo-AVR due to mechanical AV dysfunction and cardiac CT before redo-AVR were included. The presence of pannus, encroachment ratio by pannus, and limitation of motion (LOM) were evaluated on CT. The diagnostic performance of pannus detection was compared using TEE, CT, and CT + TEE, with surgical findings as a standard reference. The added value of CT for diagnosing the cause of mechanical AV dysfunction was assessed compared to TTE + TEE. Results In two patients, CT analysis was not feasible due to severe metallic artifacts. On CT, pannus and LOM were found in 100% (23/23) and 60.9% (14/23). TEE identified pannus in 48.0% of patients (12/25). CT, TEE, and CT + TEE correctly identified pannus with sensitivity of 92.0%, 48.0%, and 92.0%, respectively (P = 0.002 for CT vs. TEE). In 11 of 13 cases (84.6%) with inconclusive or negative TEE results for pannus, CT detected the pannus. Among 13 inconclusive cases of TTE + TEE for the cause of mechanical AV dysfunction, CT suggested 6 prosthetic valve obstruction (PVO) by pannus, 4 low-flow low-gradient PVO, and one LOM without significant PVO. Conclusions Cardiac CT showed added diagnostic value with TEE in the detection of pannus as the cause of mechanical AV dysfunction. [ABSTRACT FROM AUTHOR]

Background The long-term prognostic value of the computed tomography (CT)-based SYNTAX score has not yet been investigated. The aim of our study was to investigate the prognostic value of the CT-SYNTAX score in predicting major adverse cardiac events (MACEs) in populations who underwent both coronary computed tomography (CCTA) and invasive coronary angiography (ICA), compared with prognostic values of coronary artery disease (CAD) findings on CCTA and the ICA-based SYNTAX score. Methods We retrospectively included 339 patients (213 men, mean age of 63.8 ± 9.45 years) with suspected CAD who underwent CCTA and ICA. SYNTAX score was obtained based on both CCTA and ICA. Follow-up clinical outcome data regarding composite MACEs were obtained. Cox proportional hazard models were developed to predict MACEs based on clinical variables, number of CAD vessels, and SYNTAX scores based on CCTA and ICA. The time-dependent receiver operating characteristic curve method was used, and the integrated area under the curve (iAUC) was calculated to compare the predictive prognosis of the models. Results During the median follow-up of 1374 days, there were 30 MACEs. In multivariate Cox regression adjusted for clinical variables, SYNTAX score group 4 (≥ 33) on CCTA and SYNTAX score groups 3 (23–32) and 4 (≥ 33) on ICA showed increased hazard ratios for MACEs compared to SYNTAX score group 1 (0). CT-SYNTAX score demonstrated no significant difference in iAUC compared with ICA-SYNTAX score and the number of vessels of CAD on CCTA. Conclusions CT-SYNTAX score can be a useful method for non-invasively predicting MACEs, especially in patients with complex CAD. [ABSTRACT FROM AUTHOR]

Abstract: While valvular involvement of rheumatic heart disease can be easily detected with conventional echocardiography by evaluating morphologic change of the valve, it still remains problematic to determine whether there is myocardial fibrosis after rheumatic fever and if yes, how much extent it involves. This case demonstrated that contrast-enhanced magnetic resonance imaging could exactly detect and define the extent of myocardial fibrosis in a patient with rheumatic valvular heart disease by comparing surgically obtained tissue analysis. [Copyright &y& Elsevier]