Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features.

Aims: Morphological characteristics of paravalvular leakage (PVL) have not yet been well characterized by computed tomography (CT). The purpose of this study was to demonstrate the morphological characteristics of PVLs using cardiac CT in patients diagnosed with PVL.

Methods and results: Between May 2011 and December 2013, 46 patients who had been diagnosed with PVL and underwent cardiac CT were included in this study. On CT, the characteristics of PVLs including number, size, location, and shape are described. Inter- and intra-observer agreement of CT were assessed. The extent of PVL on CT and the degree of regurgitant grade on echocardiography are compared. The size of PVLs were compared between patients who underwent surgical correction and who treated with percutaneous device closure or observed without treatment. All PVLs detected on surgical filed were the same with the number and locations of PVLs demonstrated on CT. Interobserver agreement for CT measurements of the PVL was good, ranging from 0.78 to 0.99. The sizes of PVL were smaller in patients who treated with device closure or observed without treatment compared to those in patients who underwent surgical correction (median areas of aortic PVL, 64.5 vs. 15.5 mm2 and mitral PVL, 40.0 vs. 27.0 mm2). PVL sizes were larger in patients with higher regurgitant grades on echocardiography (P < 0.05).

Conclusion: Cardiac CT can demonstrate the location and size of PVL. The size of PVLs are larger in patients who managed by surgical correction. PVL size measured on CT is correlated with the regurgitant grade on echocardiography.