Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions

Abstract

The role of noninvasive imaging to help guide transcatheter aortic valvular interventions is well established and has grown with the advances in the procedure. With the rapid development of new transcatheter mitral valve interventions there is both an opportunity and a challenge for noninvasive imaging to grow understanding of mitral valve anatomy and disease, help with patient selection, and improve downstream clinical outcomes. This review will discuss the role of both echocardiography and multidetector CT in the diagnosis of mitral regurgitation, as well as grading of its severity and defining its etiology. Additionally, new concepts including measurements pertaining to mitral annular sizing, segmentation of mitral annular calcium, prediction of neo-left ventricular out flow tract obstruction, hybrid or fusion multidetector CT/echocardiographic imaging, and CT-based fluoroscopic guidance will be discussed.

Cardiac CT angiography: normal and pathological anatomical features—a narrative review

“…A good correlation, although with systematic overestimation, of CT-derived MV planimetric area with that of Doppler transthoracic echocardiography (TTE) and cardiac catheterization has been demonstrated (39). CCTA plays an important role in defining the landing zone for transcatheter MV intervention, offering highly reproducible evaluation of the 3D geometry of the MV annulus (40). CCTA provides a detailed and clear definition of the extent and severity of annular calcium, which can help determine device suitability (40).…”

“…CCTA plays an important role in defining the landing zone for transcatheter MV intervention, offering highly reproducible evaluation of the 3D geometry of the MV annulus (40). CCTA provides a detailed and clear definition of the extent and severity of annular calcium, which can help determine device suitability (40). Finally, CCTA offers the substantial advantage of the accurate preoperative assessment of CAD in patients with valvular heart disease when surgery or an intervention is planned.…”

Multimodality Imaging in Secondary Mitral Regurgitation

“…The upper reference limit of normal for indexed mitral annulus area by 3D TOE is 6.9 cm 2 /m 2 (39). While 3D TTE and TOE are gold standard, there is increasing evidence supporting the use of ECG-synchronized 3D multi-detector CT in the planning of TMVR, particularly for assessing annulus dimensions, landing zones, alignment with the inter-commissural lines for coaxial deployment and prevention of LVOT obstruction (40).…”

CT Imaging for Mitral Valve Surgery and Intervention

“…승모판고리는 비대칭적인 모양으로 3차원적으로 보면 안장모양(saddle-shape)의 구조물이다 (10). 승모판고리는 앞뿔(anterior horn or peak)과 뒤뿔(posterior horn)로 이루어져 있는데 앞 뿔은 대동맥 근위부쪽을 향하여 위쪽으로 뻗어 있으며 소위 'aortomitral continuity' 혹은 'intervalvular fibrosa'를 형성한다 (1,6) MV는 2개의 첨판(leaflet), anterior mitral leaflet (이하 AML)과 posterior mitral leaflet (이하 PML)로 이루어져 있다. 각 첨판은 각각 3개의 scallop (A1, A2, A3 in AML; P1, P2, P3 in PML)으 The lateral (blue arrow) and medial (green arrow) trigones define the border between the anterior circumference (aortic peak) and posterior circumference (posterior peak).…”