Systematic CT Methodology for the Evaluation of Subclinical Leaflet Thrombosis
Hasan Jilaihawi, Federico M. Asch, Eric Manasse, Carlos E. Ruiz, Vladimir Jelnin, Mohammad Kashif, Hiroyuki Kawamori, Yoshio Maeno, Yoshio Kazuno, Nobuyuki Takahashi, Richard Olson, Joe Alkhatib, Daniel Berman, John Friedman, Norman Gellada, Tarun Chakravarty and Raj R. Makkar
(Top) HALT is assessed in a diastolic phase with visualization of leaflet coaptation required for a conclusive scan. There is an additional assessment of the valve leaflets in the presence of HALT in the diastolic phase. Basal leaflet thickness is measured, and leaflet orientation of thickened leaflets is described (Figure 4). Stent frame characteristics, which may influence the development of HALT, are also assessed (middle [Figure 5]). In the presence of HALT, RELM is quantified in a systolic phase with a VR en face projection (bottom) at maximal leaflet opening (Figures 1 and 2). Moderate, severe, or leaflet immobility on RELM analysis in the presence of HALT is described as HAM. With inconclusive HALT (or HAM), TEE may be considered.