New imaging recommendations for prosthetic heart valve assessment

Recommendations for the assessment of prosthetic heart valves using multimodality imaging including echochardiography and cardiac CT have been published in European Heart Journal: Cardiovascular Imaging.

One of the most common cardiovascular conditions, heart valve disease is estimated to affect up to 6 percent of people over the age of 65, with approximately 850,000 prosthetic heart valves expected to be implanted per year by 2050.

With so many prosthetic valves being implanted into patients, the European Society of Cardiology (ESC) set out to establish recommendations for assessing the condition of the implants using multimodality imaging.

“We have underlined the incremental value of all imaging modalities to evaluate prosthetic heart valves,” wrote lead author Patrizio Lancellotti, MD, PhD, of the University of Liège in Belgium and his colleagues.

The ESC recommendations include:

• First-line imaging with 2D transthoracic echocardiography;
• 2D and 3D TTE and transoesophageal echocardiography for complete evaluation;
• Cinefluoroscopy to evaluate disc mobility and valve ring structure;
• Cardiac CT to visualize calcification, degeneration, pannus, thrombus;
• Cardiac MRI to assess cardiac and valvular function; and
• Nuclear imaging, especially when infective endocarditis is suspected.

The recommendations have already been endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography and the Brazilian Department of Cardiovascular Imaging.

“We have introduced new algorithms to help clinicians diagnose and quantify prosthetic heart valve dysfunction,” the authors concluded. “They are easy to use and we hope will improve assessment and subsequent management of patients so that when complications do occur, better outcomes can be achieved.”