Abstract
Subclinical leaflet thrombosis (LT) may occur following surgical and transcatheter
aortic valve replacement. Computed tomography (CT) has become an established imaging
modality to diagnose subclinical LT following bioprosthetic aortic valve replacement.
Even so, there is a limited (but growing) experience in utilizing CT imaging for this
indication. This review emphasizes a systematic approach to acquiring and analysing
CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae
of subclinical LT and anti-thrombotic implications following diagnosis.
Graphical abstract

Graphical Abstract
Keywords
Abbreviations:
4D (Four-dimensional), CI (Confidence interval), CT (Computed tomography), CVE (Cerebrovascular events), DOAC (Direct oral anticoagulants), HALT (Hypo-attenuated leaflet thickening), LT (Leaflet thrombosis), OAC (Oral anticoagulation), RELM (Reduced leaflet motion), RR (Relative risk), SAVR (Surgical aortic valve replacement), TAVR (Transcatheter aortic valve replacement), VR (Volume rendering)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
Full access to the journal is a member benefit for SCCT Members, Login via the SCCT website to access all journal content.
Subscribe:
Subscribe to Journal of Cardiovascular Computed TomographyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med. 2019; 380: 1695-1705
- Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.N Engl J Med. 2019; 380: 1706-1715
- Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/Transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography.JACC Cardiovasc Imaging. 2019; 12: 1-24
- Bioprosthetic aortic valve leaflet thickening in the evolut low risk sub-study.J Am Coll Cardiol. 2020; 75: 2430-2442
- Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy.J Am Coll Cardiol. 2020; 75: 3003-3015
- Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves.Circulation. 2018; 137: 388-399
- Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research.Eur Heart J. 2021; 42: 1825-1857
- Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications.J Am Coll Cardiol. 2016; 68: 2059-2069
- Systematic CT methodology for the evaluation of subclinical leaflet thrombosis.JACC Cardiovasc Imaging. 2017; 10: 461-470
- Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves.Eur Heart J. 2017; 38: 2201-2207
- Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study.Lancet. 2017; 389: 2383-2392
- Possible subclinical leaflet thrombosis in bioprosthetic aortic valves.N Engl J Med. 2015; 373: 2015-2024
- TAVR in low-risk patients: 1-year results from the LRT trial.JACC Cardiovasc Interv. 2019; 12: 901-907
- Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves.Eur Heart J. 2016; 37: 2263-2271
- Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up.Heart Vessels. 2021;
- Bioprosthetic aortic valve leaflet thrombosis detected by multidetector computed tomography is associated with adverse cerebrovascular events: a meta-analysis of observational studies.EuroIntervention. 2018; 13: e1748-e1755
- Edoxaban versus dual antiplatelet therapy for leaflet thrombosis and cerebral thromboembolism after TAVR: the ADAPT-TAVR randomized clinical trial.Circulation. 2022; 146: 466-479
- Subclinical leaflet thrombosis after transcatheter aortic valve replacement: a meta-analysis.JACC Cardiovasc Interv. 2021; 14: 2643-2656
- The prevalence of computed tomography-defined leaflet thrombosis in intra- versus supra-annular transcatheter aortic valve prostheses.Cathet Cardiovasc Interv. 2018; 92: 1414-1416
- Clinical impact of hypoattenuating leaflet thickening after transcatheter aortic valve replacement.Circ Cardiovasc Interv. 2022; 15e011480
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-c184
- Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial.Lancet. 2017; 389: 1312-1322
- Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of radiology and the National kidney Foundation.Radiology. 2020; 294: 660-668
- Quantification of hypo-attenuated leaflet thickening after transcatheter aortic valve implantation: clinical relevance of hypo-attenuated leaflet thickening volume.Eur Heart J Cardiovasc Imaging. 2020; 21: 1395-1404
- The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement.J Cardiovasc Comput Tomogr. 2022; 16: 168-173
- Prosthesis geometrical factors in the development of hypo-attenuated leaflet thickening.J Am Coll Cardiol. 2020; 76: 1913-1914
- Prosthesis geometrical predictors of leaflet thrombosis following transcatheter aortic valve replacement with intra-annular prostheses.Heart Lung Circ. 2022;
- Alignment of Transcatheter Aortic-Valve Neo-Commissures (ALIGN TAVR): impact on final valve orientation and coronary artery overlap.JACC Cardiovasc Interv. 2020;
- Commissural alignment of bioprosthetic aortic valve and native aortic valve following surgical and transcatheter aortic valve replacement and its impact on valvular function and coronary filling.JACC Cardiovasc Interv. 2018; 11: 1733-1743
- Computed tomography features of cuspal thrombosis and subvalvular tissue ingrowth after transcatheter aortic valve implantation.Am J Cardiol. 2020; 125: 597-606
- Anticoagulation with or without clopidogrel after transcatheter aortic-valve implantation.N Engl J Med. 2020; 382: 1696-1707
- Aspirin with or without clopidogrel after transcatheter aortic-valve implantation.N Engl J Med. 2020; 383: 1447-1457
- Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC working group on thrombosis and the European association of percutaneous cardiovascular interventions (EAPCI), in collaboration with the ESC Council on valvular heart disease.Eur Heart J. 2021; 42: 2265-2269
- ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2017; 39 (2018): 213-260
- A controlled trial of rivaroxaban after transcatheter aortic-valve replacement.N Engl J Med. 2019; 382: 120-129
- Anti-thrombotic strategy to lower all cardiovascular and neurologic ischemic and hemorrhagic events after TransAortic valve implantation for aortic stenosis : a randomized, open-label, phase 3 trial.Our Heart J. 2022; 43: 2783-2797
- Apixaban and valve thrombosis after transcatheter aortic valve replacement: the ATLANTIS-4D-CT randomized clinical trial substudy.JACC Cardiovasc Interv. 2022; 15: 1794-1804
- Reduced leaflet motion after transcatheter aortic-valve replacement.N Engl J Med. 2020; 382: 130-139
- Edoxaban versus vitamin K antagonist for atrial fibrillation after TAVR.N Engl J Med. 2021; 385: 2150-2160
- Medium-term follow-up of early leaflet thrombosis after transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2018; 11: 1164-1171
- Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation.Clin Res Cardiol. 2017; 106: 85-95
- The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report.Eur Heart J Case Rep. 2020; 4: 1-5
- Early bioprosthetic valve dysfunction following TAVR: the role of CT imaging in diagnosing acute leaflet thrombosis.Heart Lung Circ. 2022;
Article info
Publication history
Published online: November 07, 2022
Accepted:
November 4,
2022
Received in revised form:
October 31,
2022
Received:
July 11,
2022
Identification
Copyright
© 2022 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.