LEAFLETS AND EXTRA–LEAFLETS HYPOATTENUATED LESIONS FOLLOWING TAVR

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.

This was an ambi–directional study. Fifty patients underwent MDCT at follow–up.

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).

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.