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Purpose of Review <p>Hypoattenuated leaflet thickening (HALT) has emerged as an important post-procedural finding after transcatheter aortic valve replacement (TAVR). HALT is characterized by localized thickening of the leaflets of bioprosthetic valves due to thrombus deposition, potentially leading to leaflet dysfunction and reduced mobility.</p> Recent Findings <p>Although initially thought to be clinically silent, HALT has now been linked with subclinical valve thrombosis and carries implications for valve durability, as well as patient outcomes, including stroke and heart failure. The introduction of advanced and multidimensional imaging techniques, particularly multi-detector computed tomography (MDCT), has led to a greater understanding of the pathophysiology of HALT, allowing for detailed visualization and assessment of leaflet morphology, function, and mobility.</p> Summary <p>This review article explores the current understanding of HALT, its pathophysiology, risk factors, clinical relevance, and the role of multimodal imaging for establishing an accurate diagnosis. We also discuss technical considerations in managing HALT, including anticoagulation strategies, their role in preventing thrombus formation and improving long-term outcomes. Additionally, we highlight the ongoing debate regarding optimal follow-up and therapeutic strategies to balance HALT-related risks with the broader clinical benefits of TAVR.</p>

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Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Replacement: Pathophysiology, Diagnosis, and Evolving Management Strategies

  • 期刊论文

  • 发表日期：

    2025年5月13日

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  • Khalid Sawalha,
  • Nitesh Gautam,
  • Neelesh Gupta,
  • Risheek Kaul,
  • Kedar Jambhekar,
  • Ahmed Hassanin,
  • Gaurav Dhar,
  • Subhi J. Al’Aref

摘要

Purpose of Review

Hypoattenuated leaflet thickening (HALT) has emerged as an important post-procedural finding after transcatheter aortic valve replacement (TAVR). HALT is characterized by localized thickening of the leaflets of bioprosthetic valves due to thrombus deposition, potentially leading to leaflet dysfunction and reduced mobility.

Recent Findings

Although initially thought to be clinically silent, HALT has now been linked with subclinical valve thrombosis and carries implications for valve durability, as well as patient outcomes, including stroke and heart failure. The introduction of advanced and multidimensional imaging techniques, particularly multi-detector computed tomography (MDCT), has led to a greater understanding of the pathophysiology of HALT, allowing for detailed visualization and assessment of leaflet morphology, function, and mobility.

Summary

This review article explores the current understanding of HALT, its pathophysiology, risk factors, clinical relevance, and the role of multimodal imaging for establishing an accurate diagnosis. We also discuss technical considerations in managing HALT, including anticoagulation strategies, their role in preventing thrombus formation and improving long-term outcomes. Additionally, we highlight the ongoing debate regarding optimal follow-up and therapeutic strategies to balance HALT-related risks with the broader clinical benefits of TAVR.