Radiographic Detection of Strut Separations in Björk–Shiley Convexo-Concave Mitral Valves

O’Neill, William W.; Chandler, James G.; Gordon, Richard E.; Bakalyar, Donovan; Abolfathi, Amir H.; Castellani, Mark; Hirsch, Jamie Lee; Wieting, David W.; Bassett, Joseph; Beatty, Karen C.; Soltis, Mary Ann; Timmis, Gerald C.; Grines, Cindy L.

doi:10.1056/nejm199508173330703

Cited by 49 publications

(27 citation statements)

References 22 publications

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“…7,8 Information quantifying postoperative risks for BSCC patients who elected to have their valves replaced is very limited. The data arise primarily from a US/UK x-ray imaging survey for the detection of fracture of 1 of the 2 legs of the outlet strut 9,10 and from the records of other prophylactic reoperations in the Netherlands and the United Kingdom. To overcome this shortcoming, published literature on redo non-BSCC prosthetic valve replacement operations were reviewed, as were unpublished data on reoperative risks among functional class I and II patients provided to the Trustees.…”

Section: See P 2717 Methodsmentioning

confidence: 99%

“…41,42 In the early to mid-1990s, a cineradiographic imaging survey was conducted among persons believed to be at elevated risk for OSF, predominantly patients with large (29ϩ mm) mitral valves. 9 The radiographic images sought evidence of fracture of 1 of the 2 legs of the outlet strut, under the assumption that such single-leg separations (SLSs) were precursors to OSF. Nearly all persons with SLSs detected opted to have the valve replaced.…”

Section: Elective Reoperations Of Bscc Valvesmentioning

confidence: 99%

“…Unpublished data on postsurgery mortality from the imaging study 9,10 are available for 33 patients with SLSs and 24 others who had elective explantation. The information was collected by the Trustees as part of the initial follow-up of the study participants.…”

Section: Elective Reoperations Of Bscc Valvesmentioning

confidence: 99%

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Twenty-Five–Year Experience With the Björk-Shiley Convexoconcave Heart Valve

et al. 2005

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Section: See P 2717 Methodsmentioning

confidence: 99%

Section: Elective Reoperations Of Bscc Valvesmentioning

confidence: 99%

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Twenty-Five–Year Experience With the Björk-Shiley Convexoconcave Heart Valve

et al. 2005

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“…Instead, it was deemed more advisable to routinely monitor the patients by acoustic [13] or radiographic [14] procedures. In one possible scenario for patient monitoring by radiographic means, a BSCC heart valve patient would report annually or semi-annually to one of the international imaging sites to have a set of X-ray images taken.…”

Section: Clinical Applicationmentioning

confidence: 99%

A medical workstation for the display and analysis of multi-frame digital cineradiographic data

Mueller

LaPresto

Powell

et al. 1996

Computers in Biology and Medicine

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Abstract--A medical workstation has been developed for the efficient display and analysis of large sets of digital cineradiographic images. Various features aid the clinician in quickly identifying and extracting the image information relevant for diagnosis: animated viewing of image frames, a digital magnifying glass for local image enlargement and enhancement, a special review queue for critical image frames, and task-oriented image processing. Double frame buffering and direct memory addressing ensure fast, artifact-free image display and transfer. Much freedom is provided for adapting the system to one's own preferences. A statistical analysis of extensive tests conducted by eight clinical expert reviewers is given.

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“…The C/C valve disc occluder can function normally unless both of the metal outlet struts have fractured; thus, the fracture of only one outlet strut, termed a single leg separation (SLS), is a precursor to many complete outlet strut fractures [2, 3]. Our effort has centered on radiographic screening using a conventional modified cineradiographic system (Siemens Hicor-Coroskop; Siemens, Islin, N.J., USA) and a newly developed direct geometric image magnification system (Feinfocus TM ; Medizintechnik, Garbsen, Germany) to allow high kVp (peak kilovoltage) imaging of the outlet struts.…”

Section: Introductionmentioning

confidence: 99%

Detection of Björk-Shiley Convexo-Concave Heart Valve Outlet Strut Single Leg Separations: Consensus Image Acquisition and Interpretation Using Two Different Cineradiographic Imaging Technologies

et al. 1999

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Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Björk-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus^TM) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.

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Radiographic Detection of Strut Separations in Björk–Shiley Convexo-Concave Mitral Valves

Abstract: Cineradiographic imaging can detect some single-leg separations in mitral convexo-concave valves and may help the estimated 41,000 patients with these valves worldwide and their physicians decide about elective valve removal.

Cited by 49 publications

References 22 publications

Twenty-Five–Year Experience With the Björk-Shiley Convexoconcave Heart Valve

Twenty-Five–Year Experience With the Björk-Shiley Convexoconcave Heart Valve

A medical workstation for the display and analysis of multi-frame digital cineradiographic data

Detection of Björk-Shiley Convexo-Concave Heart Valve Outlet Strut Single Leg Separations: Consensus Image Acquisition and Interpretation Using Two Different Cineradiographic Imaging Technologies

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