Optimizing cinefluoroscopy for accurate evaluation of mechanical prosthetic valves

Abstract Background and Aim The accurate evaluation of mechanical prosthetic heart valves (PHV) is critical in ensuring their proper function and longevity. Cinefluoroscopy (CF), a dynamic imaging technique, plays a vital role in assessing these prosthetic devices by providing real-time visualization of their motion and functionality (1, 2). However, the quality and diagnostic value of CF imaging is highly dependent on the optimization of the roentgen tube angles and the accuracy of the projections used (3). This study aims to explore and refine these technical parameters to enhance the precision and reliability of CF evaluations of mechanical prosthetic valves, thereby contributing to better patient outcomes and more effective clinical practices. Methods In our study, patients with aortic and mitral PHVs, who were evaluated using CF between October 2021 and June 2024, were assessed. The method for optimal evaluation and determination of opening and closing angles is shown in Figure 1. The manufacturer and type of PHV were recorded from hospital records. Two experienced cardiologists conducted the CF evaluation of the patients. Various tube projections were attempted until an optimal image was obtained. Patients were positioned supine, and in right and left lateral decubitus positions to achieve the best image. If optimal imaging could not be achieved in these three positions and four different projections, it was recorded as non-optimal. Results In our study, a total of 331 patients were evaluated, comprising 250 patients with aortic PHV and 81 patients with mitral PHV. The distribution of optimal projections and baseline characteristics of the study population are summarized in Figure-2. For aortic PHVs, optimal imaging was achieved in 94.8% of cases, with 87.8% of these obtained in the supine position. The most frequently achieved optimal projection for aortic PHVs was the left cranial projection. For mitral PHVs, the rate of optimal imaging was significantly lower than for aortic PHVs, achieved in 66.7% of cases, with 61.1% of these obtained in the supine position. The projection most commonly associated with optimal imaging for mitral PHVs was the right cranial projection. Conclusions This study highlights the importance of optimizing tube angles and projections in CF evaluation of PHVs. The findings demonstrate that optimal imaging is more easily achieved in aortic PHVs, particularly in the supine position with left cranial projection. However, mitral PHVs present greater challenges, with lower rates of optimal imaging. These results emphasize the need for tailored approaches to improve diagnostic accuracy in CF.