No abstract

· Soschynski M, Capilli F, Ruile P et al. Post-TAVI Follow-Up with MDCT of the Valve Prosthesis: Technical Application, Regular Findings and Typical Local Post-Interventional Complications. Fortschr Röntgenstr 2018; 190: 521 - 530.

Aims To determine the conditions under which early hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) becomes hemodynamically relevant. Methods and results The study included 100 patients (age: 81.5 ± 5.5 years; female 63%), thereof 50 patients with HALT. After anonymization and randomization, blinded readers measured maximum thrombus thickness per prosthesis (MT_pr) and movement restriction (MR_pr) on ECG-gated whole heart cycle CTA. These measurements were compared with echocardiographic mean pressure gradient (mPG), its increase from baseline (ΔmPG) and doppler velocity index (DVI). Hemodynamic valve deterioration (HVD) was defined as mPG > 20mmHg. Age, body mass index, valve type, valve size, left ventricular ejection fraction and atrial fibrillation were considered as influencing factors. Multiple regression analysis revealed that only valve size (p = 0.001) and MT_pr (p = 0.02) had a significant influence on mPG. In an interaction model valve size moderated the effect of MT_pr on mPG significantly (p = 0.004). Subgroup analysis stratified by valve sizes showed a strong correlation between MT_pr and echocardiographic parameters for 23 mm valves (mPG: r = 0.57, ΔmPG: r = 0.68, DVI: r = 0.55, each with p < 0.001), but neither for 26 mm nor 29 mm valves (r < 0.2, p > 0.2 for all correlations). Six of seven prostheses with HVD had a 23 mm valve diameter, while one had 29 mm (p = 0.02). Conclusion Early HALT rarely causes significant mPG increase. Our study shows that valve size is a key factor influencing the hemodynamic impact of HALT. In small valve sizes, mPG is more likely to increase. Our study is the first to offer in vivo evidence supporting previous in vitro findings on this topic.

Nowadays, incidental anatomical variants are frequent findings, due to the widespread diffusion of cross-sectional imaging. This case report illustrates a fairly uncommon anatomical variant, that is, the copresence of left inferior vena cava and retroaortic right renal vein reported in a 46-year-old lady, undergoing a staging CT for breast cancer. Although the patient was asymptomatic, the authors highlight potential risks related to the above-mentioned condition and the importance of correct identification and diagnosis of the findings.