AUTHOR=Derda Anselm A. , Marquardt Marvin M. , Martens Andreas , Mirena Elion , Vogel-Claussen Jens , Kempf Tibor , Haverich Axel , Bauersachs Johann , Napp L. Christian 

TITLE=Cinefluoroscopy for assessment of mechanical heart valves with suspected dysfunction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.952255

DOI=10.3389/fcvm.2022.952255

ISSN=2297-055X

ABSTRACT=Background
Mechanical heart valves are preferred prosthesis types in many, especially younger
patients who need surgical valve replacement. Although echocardiography is most
frequently used for prosthesis assessment during follow-up, ultrasound artifacts usually
preclude precise investigation of prosthesis function. Cinefluoroscopy is a simple and
effective method to analyze and quantify opening and closing of prosthesis leaflets, but
requires careful visualization of the valve using optimal viewing angles. Here we
investigated the quality of cinefluoroscopy studies in clinical routine and their suitability
for quantitative analysis of prosthesis function.
Methods and Results
We retrospectively identified 94 patients with 118 cinefluoroscopies, performed by 31
different investigators in one tertiary center from 2012 to 2021. Of 150 mechanical
heart valves (98% dual leaflet prostheses), 87 were aortic (58%), 53 mitral (34%),
7 tricuspid (5%), and 5 pulmonary (3%) valve prostheses, respectively.
Cinefluoroscopies were categorized by their suitability to quantitatively assess opening
and closing angles. Visualization of valve function was “sufficient” in 23%, “suboptimal”
in 46%, and “unsuitable” in 31% of cases.
Conclusions
In clinical routine, only one fourth of cinefluoroscopy studies allows for complete
assessment of leaflet motion of mechanical heart valves. Although this may be in part
due to varying experience of operators, the high number of unsuitable studies suggests
that optimal viewing angles may not be achievable in all patients. Further research is
required to investigate standard viewing angles and anatomy after mechanical heart
valve implantation, to improve quality of cinefluoroscopy studies and reduce radiation
exposure for patients and operators.