Valvular Heart Disease: Letter Cardiology 2020;145:652–653 Substantial Value of Cardiac Computed Tomography for the Evaluation of Patients with Suspected Prosthetic Valve Dysfunction Macit Kalcik a Ahmet Güner b Sabahattin Gündüz c Mehmet Özkan c, d a Department of Cardiology, Faculty of Medicine, Hitit University, Corum, Turkey; b Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey; c Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey; d Division of Health Sciences, Ardahan University, Ardahan, Turkey Received: June 23, 2020 Accepted: June 26, 2020 Published online: September 8, 2020 Macit Kalcik Department of Cardiology Faculty of Medicine, Hitit University Buharaevler Mah. Buhara 25. Sok. No:1 /A, Daire:22, Çorum (Turkey) macitkalcik @yahoo.com © 2020 S. Karger AG, Basel karger@karger.com www.karger.com/crd DOI: 10.1159/000509917 Dear Editor, We recently read with great interest the article by Hsu et al. [1] entitled ‘‘Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function”. We ap- preciate the contribution made by these authors in this report on the beneficial use of cine-computed tomogra- phy (CT) in the evaluation of patients with suspected prosthetic aortic valve dysfunction. Furthermore, we would like to contribute to their report by drawing atten- tion to the role of cardiac CT for the differentiation of periprosthetic masses as a complementary diagnostic tool to transesophageal echocardiography (TEE) in the evalu- ation of prosthetic heart valves (PHV). Several noninvasive imaging modalities are available for the assessment of PHV function [2]. Transthoracic echocardiography is usually the first imaging modality to evaluate suspected PHV dysfunction, but usually offers inadequate images for making differential diagnosis of the thrombus, pannus, and vegetation, due to the acoustic shadowing and low resolution caused by prosthetic mate- rial. Furthermore, as emphasized by the authors, in- creased transvalvular flow velocities and pressure gradi- ents measured by Doppler echocardiography may be observed due to increased pressure recovery or patient- prosthesis mismatch in the absence of valvular obstruc- tion. Thus, an abnormality detected on Doppler echocar- diography should be further investigated by TEE or car- diac CT which can be useful for evaluating the etiology (i.e., thrombus vs. pannus) of the valvular obstruction. Real-time 3-dimensional (RT-3D) TEE, in particular, provides better visualization of the atrial and ventricular sides of mitral prostheses, improves the understanding of the relation between cardiac structures, and helps in dis- criminating the pannus from the thrombus [3, 4]. How- ever, RT-3D TEE has limited ability in the evaluation of aortic PHV due to the distance between the esophagus and the aortic valve. Cinefluoroscopy is a noninvasive, readily available method for detecting PHV dysfunction, especially in patients with bileaflet prosthetic valves, and it can play a complementary diagnostic role in evaluating the disk mobility of the prostheses [5]. Cardiac CT can complement TEE and become an emerging diagnostic tool in the evaluation of mechanical prosthetic valves [6]. Attenuation values of the abnormal masses adjacent to the prosthetic valves may provide quan- titative data for the differentiation of pannus and throm- bus formation. Based on the histopathologic differences between the pannus and thrombus, X-ray attenuation of