Three-Dimensional Echocardiography Compared With Computed Tomography to Determine Mitral Annulus Size Before Transcatheter Mitral Valve Implantation

Abstract

Background-Previously, through the use of computed tomography (CT), it has been proposed that D-shaped versus saddleshaped mitral annulus (MA) segmentation is more biomechanically appropriate to determine transcatheter mitral valve implantation size and eligibility. Methods and Results-Forty-one patients with severe mitral regurgitation being considered for transcatheter mitral valve implantation who had undergone cardiac CT and 3-dimensional transesophageal echocardiography (3D-TEE) were retrospectively evaluated. A standardized segmentation protocol for the D-shaped MA was developed using Philips Q-Laboratory mitral valve quantification software. MA dimensions were compared using Spearman's rank correlation and Bland-Altman analysis. Inter-and intraobserver agreement was quantified by intraclass correlation coefficient and Bland-Altman analysis. Mean age was 77±14 years; 71% male (n=29); mitral regurgitation pathogenesis was functional in 54% (n=22) and myxomatous in 46% (n=19

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

“…Tube voltage and tube current should be adapted to body habitus as per routine cardiac CT protocols (47). A complimentary nongated low-dose chest transseptal approach is being considered (typically achieved with a single breath hold following injection of 80-110 mL of intravenous contrast media at 4-5 mL/sec and a biphasic injection between annular measurements obtained by using 3D TEE and those obtained by using CT (48). Given the high temporal resolution of TEE, it can provide important insight into mitral annular dynamism and function.…”

Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy

“…13,14 All datasets underwent blinded analysis at a single core laboratory. Coronary atherosclerosis evaluation by CTA was performed on multiplanar and cross-sectional images by Level III-experienced readers masked to clinical results using semi-automated plaque analysis software (QAngioCT Research Edition v2·1·9·1; Medis Medical Imaging Systems, Leiden, the Netherlands) with manual correction.…”

Multimodality Imaging in Transcatheter Mitral Interventions

“…The idea of the D-shaped annulus has been popularized in recent literature as a method to measure the mitral annulus, which simplifies the annulus shape while making it more planar; this is also partially based on the observation that the anterior saddle as a portion of the annulus measurement projects past the anterior mitral leaflet into the left ventricular outflow tract. 15 As a continuation of these investigations, Mak et al, 16 in this issue of Circulation: Cardiovascular Imaging, use the Mitral Valve Quantification program (Philips Healthcare, Inc., Andover, MA) in a modified fashion to perform a D-shaped segmentation of the mitral annulus using 3D-TEE similar to the same group's original method on a semiautomated MDCT software segmentation. In this analysis of 41 patients, annular area and circumference, were not different when comparing MDCT and 3D-TEE measurements.…”

“…The impact of this phenomenon on sizing of transcatheter mitral valves is unclear. All of the analyses by Mak et al 16 were performed in diastole, where typically the annulus plane is easier to appreciate. However, existing studies of mitral annular dynamism based on 3D-TEE have shown the largest dimensions in late systole.…”

“…As both Mak et al 16 and Suh et al 20 have shown, advances in imaging technology result in multiple imaging options, which allow us to best assess our patients. This will be crucial not only in structural interventions but in other areas of cardiology.…”