A new multisociety expert consensus document (ECD) published in JACC addresses the evolving use of cardiac CT imaging and how to best use it to assess different types of prosthetic heart valve (PHV) dysfunction.

The ECD, led by Writing Group Chair Ricardo P. J. Budde, MD, PhD, provides an overview of heart valve repairment techniques and summarizes the available imaging modalities for PHV, including transthoracic and transesophageal echocardiography, CT imaging, cine fluoroscopy and nuclear imaging. It then dives deeper into CT acquisition protocols for PHV imaging; CT findings in normal functioning PHV; types of PHV dysfunction; (para)valvular leakage; patient prosthesis mismatch; endocarditis; structural valve deterioration/dysfunction; and hypo-attenuated leaflet thickening – providing consensus statements based on the latest data available and expert opinion.

Among the key takeaways, the ECD highlights the need to tailor the CT acquisition protocol to each patient based on the type and location of the PHV. Additionally, the authors note nearly all PHV types can be adequately assessed dynamically and statically with CT using dedicated imaging reformations to optimize viewing planes. The ECD also addresses the valuable role of CT in preoperative planning for reoperation following valve surgery and provides recommendations for reporting CT scan assessments performed for PHV dysfunction using a structured template and as part of a multidisciplinary meeting. Emerging technologies, including photon-counting detector-CT and 4D-CT are also touched upon as opportunities in the years to come.

“Echocardiography is the imaging modality of first choice to evaluate PHV function,” write Budde and colleagues. “However, in the last 15 years CT has proven to be a valuable complementary technique to assess PHVs, especially in determining the cause of PHV dysfunction, the diagnosis of PVE and for providing important information in case of a planned re-operation to replace the dysfunctional PHV. … The role of CT is expected to only grow in the future.”

The consensus document is co-authored by the ACC, the Society of Cardiovascular Computed Tomography (SCCT), the European Society of Cardiovascular Radiology (ESCR), the North American Society of Cardiovascular Imaging (NASCI), the Radiological Society of North America (RSNA), the Society for Cardiovascular Angiography & Interventions (SCAI) and Society of Thoracic Surgeons (STS).