Korean Circ J.  2020 Jul;50(7):572-582. 10.4070/kcj.2019.0385.

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

• Lim SJ
• Koo HJ
• Jung SC
• Kang DY
• Ahn JM
• Park DW
• Park SJ
• Yang DH
• Kang JW

• KMID: 2504215
• DOI: http://doi.org/10.4070/kcj.2019.0385

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.

Keyword

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

Figure

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  Figure 1 Multiplanar-reconstructed CT images of sinus of Valsalva thrombosis in the 8 patients.CT = computed tomography.

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  Figure 2 An 85-year-old woman diagnosed with severe aortic stenosis. (A, B) Diffusion-weighted magnetic resonance images and (C) FLAIR image obtained 9 days after TAVR. Hyperintense acute infarction lesions can be noted in right parietal and left occipital lobes. (D, E) Cardiac gated CT obtained 177 days after TAVR shows low attenuation thrombus in the non-coronary sinus of Valsalva, and (F) FLAIR image acquired at the same time shows new cortical/subcortical hyperintensity consistent with prior embolic infarction.CT = computed tomography; FLAIR = fluid attenuated inversion recovery; TAVR = transcatheter aortic valve replacement.

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  Figure 3 A 79-year-old woman who underwent TAVR. (A, B) Diffusion-weighted magnetic resonance images and (C) FLAIR image obtained 3 days after TAVR. Hyperintense acute infarction lesions were noted in the right frontal lobe. (D, E) Cardiac gated CT obtained 184 days after TAVR shows low attenuation thrombus in the non-coronary sinus of Valsalva, and (F) FLAIR image acquired at the same time shows new subcortical white signal intensity consistent with prior embolic infarction.CT = computed tomography; FLAIR = fluid attenuated inversion recovery; TAVR = transcatheter aortic valve replacement.

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