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Sinus of Valsalva Thrombosis Detected on Computed Tomography after Transcatheter Aortic Valve Replacement

Korean Circulation Journal 2020년 50권 7호 p.572 ~ 582
임수진 ( Lim Su-Jin ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology

구현정 ( Koo Hyun-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
정승채 ( Jung Seung-Chai ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
강도윤 ( Kang Do-Yoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
안정민 ( Ahn Jung-Min ) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
박덕우 ( Park Duk-Woo ) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
박승중 ( Park Seung-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology
양동현 ( Yang Dong-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
강준원 ( Kang Joon-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology

Abstract


Background and Objectives: Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis.

Methods: Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated.

Results: The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants.

Conclusions: Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.

키워드

Aortic valve stenosis; Multidetector computed tomography; Transcatheter aortic valve replacement; Thrombosis; Sinus of valsalva
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