CTICasesTranscatheter Aortic Valve Replacement (TAVR) Leaflet Thrombosis with Restricted Motion
Imaging findings
Multiplanar cardiac CT reconstruction of a TAVR valve (Portico valve) shows abnormal, hypoattenuating thickening of two out of the three bioprosthetic valve leaflets. Dynamic 4D CT reconstruction demonstrates highly restricted motion of the affected leaflets, particularly at their bases. Concomitant thrombus is also noted in the left atrium and left atrial appendage.
Key takeaways
Subclinical bioprosthetic valve leaflet thrombosis is an increasingly recognized phenomenon after TAVR, characterized on CT by hypoattenuating leaflet thickening (HALT) and reduced leaflet motion (RLM). While echocardiography may not always show an increased transvalvular gradient, 4D CT is highly sensitive for diagnosis. Anticoagulation is typically effective at resolving the thrombus and restoring normal leaflet excursion.
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