Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Abstract

New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

“…Full preoperative multimodality imaging has been recommended as the best of the many available options for treating a complex disease such as MVR. [ 51 ]. Preoperative planning may include 3-D reconstruction of a patient’s anatomy, rapid prototyping and computational modeling [ 52 , 53 , 54 ] for both MIVS and TMVR, including transcutaneous mitral valve replacement [ 55 ].…”

Multi-modality imaging for pre-procedural planning of transcatheter mitral valve interventions

“…Different methods are available such as qualitative (visualization of color-Doppler regurgitant jet area and evaluation of continuous wave Doppler signal), semi-quantitative (vena contracta width, mitral inflow velocity, and pulmonary vein flow pattern), or quantitative [effective regurgitant orifice area (EROA), regurgitant volume (RVol), and regurgitant fraction (RF) by PISA or volumetric method]. As a true gold standard for accurate MR grading is not available, a multi-parametric approach is the cornerstone for a reliable quantification of MR. 8 , 9 …”

“…It has acquired an emerging role in the context of MV as a quantitative method to assess MR in discordant cases or when echocardiography is of suboptimal quality, also in the contest of multi-valvular disease, without limitations of imaging window or body habitus. 9 RVol and RF are calculated as the difference between LV total stroke volume and forward flow. In the upcoming years, the potential advancement of the 4D-flow CMR retrospective valve tracking method, quantifying flow directly at MV, could further improve CMR assessment.…”

“…In the upcoming years, the potential advancement of the 4D-flow CMR retrospective valve tracking method, quantifying flow directly at MV, could further improve CMR assessment. 9 Moreover, CMR allows to characterize the extent of scarring and myocardial viability in secondary mitral regurgitation 11 and the presence and the extent of myocardial fibrosis in primary mitral regurgitation that has been associated with sudden cardiac death and ventricular arrhythmias. 12 …”

“…In absence of specific contraindications, according to Carpentier’s Classification, a leaflet repair approach is suitable for treating Types II and IIIb and suboptimal for Type I; annular approach is most appropriate for Types I and IIIb if limited leaflet tethering is present. 9 When successful and durable repair is not achievable, MV replacement should be preferred over repair. In the field of redo surgery (failing bioprosthesis/rings), the convincing results for the valve-in-valve (ViV) technique suggest that it should be considered as a first-line option.…”