Multidetector-row computed tomography allows accurate measurement of mechanical prosthetic heart valve leaflet closing angles compared with fluoroscopy

The purpose of this study was to compare multidetector-row computed tomography (MDCT) leaflet restriction measurements with fluoroscopy measurements in commonly used mechanical prosthetic heart valves (PHVs). Four mechanical PHVs (ON-X, Carbomedics, St. Jude, and Medtronic Hall) were imaged in a pulsatile model using fluoroscopy and 64-detector-row computed tomography. Five image acquisitions of each PHV without (1) and with (4) restricted leaflet closure were made. Three observers measured closure angles on fluoroscopy and MDCT. Data were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. Interobserver agreement was high in restricted and non-restricted leaflets on both modalities (ICCs >0.995). MDCT and fluoroscopy showed high agreements (ICCs >0.989). Median MDCT closure angle measurements differed at most -2 to +2 degrees from fluoroscopy in the restricted and -1 to +2 degrees in the non-restricted leaflets. MDCT allows measurement of leaflet motion with a maximal median discrepancy of 2 degrees. Both MDCT and fluoroscopy detect restricted leaflet closure with great accuracy.