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A 79-year-old female with severe aortic stenosis and hypertension was referred for
transcatheter aortic valve replacement (TAVR). Computed tomography (CT) was performed
for prosthesis sizing and ilio-femoral assessment (Figure 1A). She received aspirin and clopidogrel prior to TAVR. The patient received intra-arterial
heparin (100 IU/kg) to achieve an activated clotting time above 250 seconds. A 23
mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA USA) was implanted (Figure 1B) and aortogram revealed no regurgitation.
Figure 1Pre-procedural computed tomography (CT) imaging (Image A) for prosthesis sizing revealed
an annulus area of 340 mm2 and area-derived diameter of 21 mm. A 23 mm Sapien 3 valve was implanted and the
procedure was well tolerated (Image B). On Day 1, the patient had residual significant
transvalvular gradient with a peak velocity of 3.9 m/s and mean gradient of 36 mmHg
(Image C). The leaflet was not visualised with transthoracic echocardiography, highlighted
a limitation with this imaging modality to diagnose leaflet thrombosis (LT) (Image
D). Post-procedural CT imaging revealed hypo-attenuated leaflet thickening (green
arrowhead) of a single leaflet in both short-axis (Image E) and long-axis views (Image
F). The prosthesis appeared under-expanded at the annular level (Images B and F, white
asterisk). Four-dimensional (4D) volume rendering revealed significant restriction
of leaflet mobility with a large thrombus burden (Images G & H) (blue arrowhead).
The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report.
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector computed tomography is associated with adverse cerebrovascular events: a meta-analysis of observational studies.
Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up.
