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A 58-year-old male patient, with a history of mitral valve replacement and coronary artery bypass surgery 10 years earlier, was treated with a cardiac resynchronisation therapy and defibrillator (CRT-D) device because of poor left ventricular function, left bundle branch block and first-degree atrioventricular block. However, during this procedure a dissection of the coronary sinus occurred. A second attempt to re-implant a ventricular lead of his CRT-D was planned. Two days before this intervention, a contrast-enhanced dual slice electron beam tomographic scan (e-Speed, Imatron, San Francisco, California, USA) was performed to visualise the coronary sinus. The coronary sinus showed a normal calibre and probably a dissection flap proximally.
Moreover, the scan showed the stainless St Jude 31 prosthesis between the left ventricle and the left atrium (panels A, B). A high concentration of contrast is visible in the right atrium. A three-dimensional image of the valve in systole was made using volume rendering (panel C). The orifice area was planimetrically calculated to be 2.4 cm2 (mean of three measurements: 2.4, 2.4 and 2.5 cm2; panel D). Echocardiography routinely performed 5 months earlier measured a mitral valve area of 2.4 cm2, in accordance with our findings. In conclusion, it is possible to visualise St Jude prosthetic valves with electron beam tomography. Electron beam tomography may be a suitable technique to evaluate some functional aspects of mechanical prosthetic valves.
Acknowledgments
This article has been adapted from Piers L H, Dikkers R, Boonstra P W. Visualisation of a St Jude prosthetic mitral valve using electron beam tomography Heart 2007;93:302