Preprocedural planning of transcatheter mitral valve interventions by multidetector CT: What the radiologist needs to know

Abstract

Mitral regurgitation is the most common valve disorder in the Western world, and although surgery is the established therapeutic gold standard, percutaneous transcatheter mitral interventions are gaining acceptance in selected patients who are inoperable or at an exceedingly high surgical risk. For such patients, multidetector computed tomography (MDCT) can provide a wealth of valuable morphological and functional information in the preoperative setting. Our aim is to give an overview of the MDCT image acquisition protocols, post-processing techniques, and imaging findings with which radiologists should be familiar to convey all relevant information to the Heart Team for successful treatment planning.

Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography

“…This is mainly due to its non-invasiveness and its high spatial resolution providing isotropic voxels enabling the reconstruction of images of the heart with equal quality in any arbitrary plane [ [10] , [11] , [12] , [13] , [14] ]. Specifically, CT allows for an assessment of the mitral valve apparatus including the leaflet/annulus complex with high accuracy [ [14] , [15] , [16] , [17] ]. In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) relevant mitral valve disease frequently coexists in around one third of patients [ 18 , 19 ].…”

Current Devices in Mitral Valve Replacement and Their Potential Complications

“…Asymmetrical annular calcification may interfere during valve implantation, with a higher risk of embolization if it is present along the device-grasping zone. Protruding calcification of the anterior leaflet can be displaced into the LVOT, causing LVOT obstruction (17). The length of the leaflets, especially the anterior one, is important.…”

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

“…The technical suggestion for optimal analysis of MV apparatus is the retrospective ECG-gated acquisition of R-R interval from 0% to 90%, in order to have all the datasets available for MPR and correction of arrhythmia-related artifacts. Moreover, to limit the artifacts and increase the temporal resolution, a CT scanner with 64 detector rows is recommended [32] . MDCT, thanks to its excellent bloodtissue interface and the high-spatial 3D imaging, provides a comprehensive visualization of cardiac and vascular structures and can give detailed information on mitral annular shape and sizing, valvular calcification, papillary muscles position and dimension, LV shape and dimension, and the relationship of the heart with chest wall.…”

“…A minimum distance of 2.5 mm from the patch of the anchor to the LCX is required to avoid lesion of the artery. Dedicated software based on MDCT can provide the expected intraprocedural fluoroscopic projections and the 3D preview of the final system position [32,46] .…”