• 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.
• Heart Valve Center, New York University Langone Medical Center, New York, New York. Electronic address: hasanjilaihawi@gmail.com.
• JACC Cardiovasc Imaging. 2017 Apr 1; 10 (4): 461-470.

AbstractSubclinical leaflet thrombosis was recently described in a randomized trial of transcatheter aortic valve replacement. It was subsequently demonstrated in a series of registries that this was a commonly observed imaging finding seen in all transcatheter and surgical bioprostheses. The phenomenon has aroused considerable interest due to the as-yet-undefined risk for later clinical events and the possibility of pharmacological intervention with anticoagulation. Subclinical leaflet thrombosis is easily detected noninvasively by technically suitable computed tomography (CT) with a high degree of concordance to transesophageal echocardiography findings. The CT hallmarks were noted to be hypoattenuated leaflet thickening (HALT) associated with reduced leaflet motion (RELM). The combination of HALT and RELM signified hypoattenuation affecting motion, the standardized imaging endpoint used. This paper describes the systematic CT evaluation methodology that was devised during the Portico trial investigation and U.S. Food and Drug Administration submission; it also highlights the need for an ongoing discussion among experts to enable, with the help of the Valve Academic Research Consortium, standardization of reporting of this imaging finding to cater to the present and future needs of clinical trials.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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