Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease

Abstract

Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.

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

“…The mitral valve apparatus on the other hand comprises much more than a simple annular plane between the left atrium and LV. Rather, the mitral valve apparatus includes a fibrous annulus, chordae, and papillary muscles and their attachments, as well as the mitral valve leaflets (6,10,11,15) (Fig 1).…”

“…Historically, the role of noninvasive imaging for the assessment of the mitral valve has been largely limited to the assessment of hemodynamic disturbances through the use of echocardiography (7)(8)(9). With the introduction of percutaneous annuloplasty devices, transcatheter mitral valve (TMV) repair and TMV replacement (TMVR), noninvasive imaging is playing an ever-greater role in the anatomic and functional evaluation (10)(11)(12)(13). Importantly, echocardiography is no longer the only test needed for mitral evaluation.…”

Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads

“…In addition, older intracardiac devices (particularly ICDs) were not designed to be MRI conditional, albeit with recent experience demonstrating safety of MRI with many of these devices . Nonetheless, the utility of this imaging modality is emerging in TR, with specific recommendations for local expertise when it comes to TR in the setting of intracardiac RV device leads . A recent pilot study demonstrated that although using traditional echocardiographic indices of TR severity had modest correlations when assessed by cardiac MRI, novel MRI‐specific indices show more promise in terms of intra‐ and interobserver consistency .…”

The frontier in Cardiac Surgery is intellectual

“…The risk is to become insensitive to technological evolutions and new skills that could be acquired. Due to the technological refinement, cardiac CT is a routine part of assessment in transcatheter therapies [46] . The sequential incorporation of increasingly sophisticated software has Learning to analyze a cardiac CT scan, measuring the size of the valve rings, the areas, the distance of the coronary arteries from the annulus, are skills acquired with great speed and precision by those who see and understand the cardiac structures with their own eyes in the daily practice.…”