Multimodality Imaging of Complications of Cardiac Valve Surgeries

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 2.75
Procedures: 2.75
Diagnostic and Electrophysiology Procedures: 2.75

Computed Tomography: 2.75
Procedures: 2.75
Neck and Chest: 2.75

Nuclear Medicine Technology: 0.75
Procedures: 0.75
Other Imaging Procedures: 0.75

Radiography: 0.75
Procedures: 0.75
Thorax and Abdomen Procedures: 0.75

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Thoracic Section: 2.75

Outline

1. Introduction
2. Imaging Modalities for Evaluating PHVs
3. Imaging Evaluation of PHVs
4. Complications of PHVs
   1. Hemodynamic and Pathophysiologic Consequences
      1. Stenosis
      2. Regurgitataion
      3. Stuck Leaflet
   2. Structural Abnormalities
      1. Prosthesis-Patient Mismatch
      2. Structural Failure
      3. Valve Calcification
      4. Dehiscence
      5. Paravalvular Leak
      6. Infective Endocarditis and Vegetation
      7. Abscess
      8. Pseudoaneurysm
      9. Abnormal Connections
      10. Thrombus
      11. Hypoattenuating Leaflet Thickening
      12. Pannus
      13. Aortic Dissection
5. Miscellaneous Complications
6. Imaging Approach to Prosthetic Valves and Dysfunction
7. Conclusion

Objectives

Upon completion of this course, students will:

1. state the number of PHV replacements over the past 5 decades
2. list the characteristics of an ideal PHV
3. recall the types of currently available PHVs
4. list the designs of mechanical heart valves
5. recall what stentless bioprostheses are made from
6. state the locations for placement of PHVs
7. list the imaging modalities that play a role in the evaluation of PHVs
8. name the most common first-line imaging test performed for PHV dysfunction
9. list the supplemental ultrasound modes used for evaluation of PHVs
10. describe how magnetic resonance imaging is helpful in the evaluation of PHVs
11. state the emerging technique that provides flow measurements comparable to echocardiography.
12. list the assessment methods that should be included in the evaluation of PHVs.
13. recall how mechanical valves distort at magnetic resonance imaging.
14. list the common hemodynamic and pathophysiologic consequences associated with PHVs
15. define regurgitation
16. describe how PHV regurgitation is quantified at echocardiography
17. differentiate between TTE and TEE for the evaluation of PHVs
18. recall the normal opening angle for monoleaflet valves as seen at computed tomography
19. describe the imaging modalities that allow real-time imaging across many heartbeats
20. describe the results of prosthesis-patient mismatch
21. recall the percentage of moderate prosthesis-patient mismatch seen in aortic valve replacements
22. list the factors that can help minimize prosthesis-patient mismatch
23. state the common causes of structural failure of bioprosthetic heart valves
24. recall the ideal imaging modality for demonstrating structural failures of PHVs
25. describe the most common cause of sterile valvular degeneration in a bioprosthetic valve
26. explain how valve calcification may appear at echocardiography
27. describe the most common cause of early reoperation for valvular malfunction
28. describe where dehiscence mainly occurs in the mitral valve
29. list the clinical features of dehiscence
30. list the causes of paravalvular leak
31. explain the percent of surgeries that result with large paravalvular leaks
32. describe where paravalvular leaks are seen in the mitral valve
33. list the complications associated with infective endocarditis
34. list the factors that place patients at a higher risk for pseudoaneurysm
35. describe the imaging modality that has 100 percent accuracy in the diagnosis of pseudoaneurysm
36. list the therapeutic options for pseudoaneurysm
37. state the most common type of aortocavitary fistula
38. describe the common location of a Gerbode defect
39. state the percent of thrombus related to PHVs
40. list the factors associated with a lower risk of thrombosis
41. state the most common cause of obstruction of a mechanical PHV
42. list the possible manifestations associated with obstructive thrombi
43. note the prevalence of pannus
44. describe how pannus appears at echocardiography
45. state the prevalence of aortic dissection