Introduction
Subclinical leaflets thrombosis is a condition diagnosed with multi-detector computer tomography (MDCT) characterized by a meniscal-shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self-expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms the leaflets and the extra-leaflets components, such as the valve skirt. Little is known about extra-leaflets hypoattenuated lesions localization, including the anatomic sinus level.
Methods
This was an ambi-directional study. Fifty patients underwent MDCT at follow-up.
Results
At mean follow-up was of 12 months, hypoattenuated leaflet lesion with mild to severe restricted movement was detected in 8 individuals (16%); anatomic sinus lesion was identified in 9 patients (18%) with higher prevalence in the non-coronary sinus (16%); subvalvular lesion with a variable extension toward the valve inflow, was diagnosed in 8 patients (16%). In 4 patients (8%) the anatomic sinus thrombus was ‘in overlap’ with the leaflet thrombus; in 3 patients (6%) was in continuity with the subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p=0.02)
Conclusions
This study demonstrated that hypoattenuated lesions could be identified not only at leaflet, but also at subvalvular and anatomic sinus level. The clinical relevance of such lesions remains uncertain.