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Visualization of thrombosis on a prosthetic pulmonary valve using electrocardiogram-gated multidetector computed tomography.

ABSTRACT: We report a case of prosthetic valve thrombosis in an 18-year-old man. Total surgical repair of tetralogy of Fallot was performed at 3 years of age. At the age of 18, he underwent pulmonary valve replacement because of exacerbating pulmonary trunk obstruction. After surgery, valve malfunction was suspected. We attempted to employ electrocardiogram (ECG)-gated multidetector computed tomography (MDCT). The stuck valve was clearly visualized together with a thrombus within. Thrombolytic therapy was undertaken on these findings. ECG-gated MDCT allowed us to make a definitive diagnosis of valve thrombosis as the cause of valve malfunction, which led us to avoid surgical reintervention.

SUBMITTER: Kakizaki S

PROVIDER: S-EPMC4360729 | biostudies-other | 2014 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundCombined pulmonary fibrosis with emphysema (CPFE) is a clinically meaningful syndrome characterized by coexisting upper-lobe emphysema and lower-lobe interstitial fibrosis. However, ambiguous diagnostic criteria and, particularly, the absence of objective methods to quantify emphysematous/fibrotic lesions in patients with CPFE confound the interpretation of the pathophysiology of this syndrome. We analyzed the relationship between objectively quantified computed tomography (CT) measurements and the results of pulmonary function testing (PFT) and clinical events in CPFE patients.Materials and methodsWe enrolled 46 CPFE patients who underwent CT and PFT. The extent of emphysematous lesions was obtained by calculating the percent of low attenuation area (%LAA). The extent of fibrotic lesions was calculated as the percent of high attenuation area (%HAA). %LAA and %HAA values were combined to yield the percent of abnormal area (%AA). We assessed the relationships between CT parameters and other clinical indices, including PFT results. Multivariate analysis was performed to examine the association between the CT parameters and clinical events.ResultsA greater negative correlation with percent predicted diffusing capacity of the lung for carbon monoxide (DLCO %predicted) existed for %AA (r = -0.73, p < 0.001) than for %LAA or %HAA alone. The %HAA value was inversely correlated with percent predicted forced vital capacity (r = -0.48, p < 0.001), percent predicted total lung capacity (r = -0.48, p < 0.01), and DLCO %predicted (r = -0.47, p < 0.01). Multivariate logistic regression analysis found that %AA showed the strongest association with hospitalization events (odds ratio = 1.20, 95% confidence interval = 1.01-1.54, p = 0.029).ConclusionQuantitative CT measurements reflected deterioration in pulmonary function and were associated with hospitalization in patients with CPFE. This approach could serve as a useful method to determine the extent of lung morphology, pathophysiology, and the clinical course of patients with CPFE.

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Visualization of thrombosis on a prosthetic pulmonary valve using electrocardiogram-gated multidetector computed tomography.

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