Skip to main content
SpringerLink
Log in

Role of MDCT Imaging in Planning Mitral Valve Intervention

  • Cardiac PET, CT, and MRI (F Pugliese and SE Petersen, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Recent advancements in transcatheter valvular interventions have resulted in a growing demand for advanced cardiac imaging to help guide these procedures.

Recent Findings

Both echocardiography and multi-detector computed tomography have played essential roles in the maturation of transcatheter aortic valve replacement and are now building on these experiences and helping inform the nascent field of transcatheter mitral interventions.

Summary

Advanced imaging is essential to aid in the diagnosis and determination of the mechanism of mitral regurgitation. In addition, they are integral to annular sizing, determination of the suitability of patient anatomy for specific devices and increasingly important in the determination of the risk of left ventricular outflow tract obstruction and providing appropriate patient-specific fluoroscopic angulation in advance of the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11. https://doi.org/10.1016/S0140-6736(06)69208-8.

    Article  PubMed  Google Scholar 

  2. Iung B, Baron G, Butchart EG, Delahaye F, GohlkeBärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on Valvular heart disease. Eur Heart J. 2003;24(13):1231–43. https://doi.org/10.1016/S0195-668X(03)00201-X.

    Article  PubMed  Google Scholar 

  3. Mehta RH, Eagle KA, Coombs LP, Peterson ED, Edwards FH, Pagani FD, et al. Society of Thoracic Surgeons National Cardiac Registry. Influence of age on outcomes in patients undergoing mitral valve replacement. Ann Thorac Surg. 2002;74(5):1459–67. https://doi.org/10.1016/S0003-4975(02)03928-0.

    Article  PubMed  Google Scholar 

  4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. ACC/AHA task force members. 2014 AHA/ ACC guideline for the Management of Patients with Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(23):e521–643. https://doi.org/10.1161/CIR.0000000000000031.

    Article  PubMed  Google Scholar 

  5. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. https://doi.org/10.1056/NEJMoa1008232.

    Article  CAS  PubMed  Google Scholar 

  6. Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23–32. https://doi.org/10.1056/NEJMoa1312808.

    Article  CAS  PubMed  Google Scholar 

  7. Feldman T, Young A. Percutaneous approaches to valve repair for mitral regurgitation. J Am Coll Cardiol. 2014;63(20):2057–68. https://doi.org/10.1016/j.jacc.2014.01.039.

    Article  PubMed  Google Scholar 

  8. Herrmann HC, Maisano F. Transcatheter therapy of mitral regurgitation. Circulation. 2014;130(19):1712–22. https://doi.org/10.1161/CIRCULATIONAHA.114.009881.

    Article  PubMed  Google Scholar 

  9. Moat N, Duncan A, Lindsay AC, Quarto C, Blanke P, Leipsic J, et al. Transcatheter mitral valve replacement for the treatment of mitral regurgitation: in hospital outcomes of first-in-man experience with an apically tethered device. J Am Coll Cardiol. 2015;65(21):2352–3. https://doi.org/10.1016/j.jacc.2015.01.066.

    Article  PubMed  Google Scholar 

  10. Cheung A, Webb J, Verheye S, Moss R, Boone R, Leipsic J, et al. Short-term results of Transapical Transcatheter mitral valve implantation for mitral regurgitation. J Am Coll Cardiol. 2014;64(17):1814–9. https://doi.org/10.1016/j.jacc.2014.06.1208.

    Article  PubMed  Google Scholar 

  11. Bapat V, Buellesfeld L, Peterson MD, Hancock J, Reineke D, Buller C, et al. Transcatheter mitral valve implantation (TMVI) using the Edwards FORTIS device. EuroIntervention. 2014;10 Suppl U:U120–8. https://doi.org/10.4244/EIJV10SUA18.

    Article  PubMed  Google Scholar 

  12. Sondergaard L, Brooks M, Ihlemann N, Jonsson A, Holme S, Tang M et al. Transcatheter mitral valve implantation via transapical approach: an early experience. Eur J Cardiothorac Surg. 2015;48(6):837–7; discussion 877-8. https://doi.org/10.1093/ejcts/ezu546

  13. Schoenhagen P, Numburi U, Halliburton SS. Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance. Eur Heart J. 2010;31(22):2727–40. https://doi.org/10.1093/eurheartj/ehq302.

    Article  PubMed  Google Scholar 

  14. • Blanke P, Naoum C, Webb J, Dvir D, Hahn R, Grayburn P, et al. Multimodality imaging in the context of Transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC Cardiovasc Imaging. 2015;8(10):1191–208. https://doi.org/10.1016/j.jcmg.2015.08.004. This paper defines the evolving role of multimodality procedures in the guidance of TMVR.

    Article  PubMed  Google Scholar 

  15. Natarajan N, Patel P, Bartel T, Kapadia S, Navia J, Stewart W, et al. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovascular Diagnosis and Therapy. 2016;6(2):144–59. https://doi.org/10.21037/cdt.2016.02.04.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Van de Heyning CM, Magne J, Vrints CJ, Piérard L, Lancellotti P. The role of multi-imaging modality in primary mitral regurgitation. Eur Heart J Cardiovasc Imaging. 2012;13(2):139–51. https://doi.org/10.1093/ejechocard/jer257.

    Article  PubMed  Google Scholar 

  17. Alkadhi H, Wildermuth S, Bettex DA, Plass A, Baumert B, Leschka S, et al. Mitral regurgitation: quantification with 16-detector row CT—initial experience. Radiology. 2006;238:463.

    Article  Google Scholar 

  18. Vural M, Ucar O, Celebi OO, Cicekcioglu H, Durmaz HA, Selvi NA, et al. Evaluation of effective regurgitant orifice area of mitral valvular regurgitation by multislice cardiac computed tomography. J Cardiol. 2010;56(2):236–9. https://doi.org/10.1016/j.jjcc.2010.06.001.

    Article  PubMed  Google Scholar 

  19. Shanks M, Delgado V, Ng AC, van der Kley F, Schuijf JD, Boersma E, et al. Mitral valve morphology assessment: three dimensional transesophageal echocardiography versus computed tomography. Ann Thorac Surg. 2010;90(6):1922–9. https://doi.org/10.1016/j.athoracsur.2010.06.116.

    Article  PubMed  Google Scholar 

  20. Guo YK, Yang ZG, Ning G, Rao L, Dong L, Pen Y, et al. Isolated mitral regurgitation: quantitative assessment with 64-section multidetector CT—comparison with MR imaging and echocardiography. Radiology. 2009;252(2):369–76. https://doi.org/10.1148/radiol.2522081714.

    Article  PubMed  Google Scholar 

  21. Killeen RP, Arnous S, Martos R, Abbara S, Quinn M, Dodd JD. Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies. Eur Radiol. 2010;20(8):1886–95. https://doi.org/10.1007/s00330-010-1760-4.

    Article  PubMed  Google Scholar 

  22. Feuchtner GM, Alkadhi H, Karlo C, Sarwar A, Meier A, Dichtl W, et al. Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography. Radiology. 2010;254(2):374–83. https://doi.org/10.1148/radiol.2541090393.

    Article  PubMed  Google Scholar 

  23. Delgado V, Tops LF, Schuijf JD, de Roos A, Brugada J, Schalij MJ, et al. Assessment of mitral valve anatomy and geometry with multislice computed tomography. JACC Cardiovasc Imaging. 2009;2(5):556–65. https://doi.org/10.1016/j.jcmg.2008.12.025.

    Article  PubMed  Google Scholar 

  24. Beaudoin J, Thai WT, Wai B, Handschumacher M, Levine R, Truong QA. Assessment of mitral valve adaptation with gated cardiac computed tomorgraphy: validation with three-dimensionsal echocardiography and mechanistic insight to functional mitral regurgitaiton. Circ Cardiovascular Imaging. 2013;6(5):784–9. https://doi.org/10.1161/CIRCIMAGING.113.000561.

    Article  PubMed  Google Scholar 

  25. • Blanke P, Dvir D, Cheung A, Ye J, Levine R, Precious B, et al. A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation. J Cardiovasc Comput Tomogr. 2014;8(6):459–67. https://doi.org/10.1016/j.jcct.2014.09.009. This paper introduced the concept of the D-shaped annulus.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Blanke P, Dvir D, Cheung A, Levine RA, Thompson C, Webb JG, et al. Mitral annular evaluation with computed tomography in the context of Transcatheter mitral valve implantation. JACC Cardiovasc Imaging. 2015;8(5):612–5. https://doi.org/10.1016/j.jcmg.2014.07.028.

    Article  PubMed  Google Scholar 

  27. Ormiston JA, Shah PM, Tei C, Wong M. Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects. Circulation. 1981;64(1):113–20. https://doi.org/10.1161/01.CIR.64.1.113.

    Article  CAS  PubMed  Google Scholar 

  28. Flachskampf FA, Chandra S, Gaddipatti A, Levine RA, Weyman AE, Ameling W, et al. Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction. J Am Soc Echocardiogr. 2000;13(4):277–87. https://doi.org/10.1067/mje.2000.103878.

    Article  CAS  PubMed  Google Scholar 

  29. Mihaila S, Muraru D, Piasentini E, Miglioranza MH, Peluso D, Cucchini U, et al. Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography. J Am Soc Echocardiogr. 2014;27(8):846–33. https://doi.org/10.1016/j.echo.2014.04.017.

    Article  PubMed  Google Scholar 

  30. Sonne C, Sugeng L, Watanabe N, Weinert L, Saito K, Tsukiji M, et al. Age and body surface area dependency of mitral valve and papillary apparatus parameters: assessment by real-time three-dimensional echocardiography. Eur J Echocardiogr. 2009;10:287–94.

    Article  PubMed  Google Scholar 

  31. Alkadhi H, Desbiolles L, Stolzmann P, Leschka S, Scheffel H, Plass A, et al. Mitral annular shape, size, and motion in normals and in patients with cardiomyopathy: evaluation with computed tomography. Investig Radiol. 2009;44(4):218–25. https://doi.org/10.1097/RLI.0b013e3181994a73.

    Article  Google Scholar 

  32. Gordic S, Nguyen-Kim TD, Manka R, Sündermann S, Frauenfelder T, Maisano F, et al. Sizing the mitral annulus in healthy subjects and patients with mitral regurgitation: 2D versus 3D measurements from cardiac CT. Int J Cardiovasc Imaging. 2014;30(2):389–98. https://doi.org/10.1007/s10554-013-0341-4.

    Article  PubMed  Google Scholar 

  33. Naoum C, Leipsic J, Cheung A, Ye J, Bilbey N, Mak G, et al. Mitral annular dimensions and geometry in patients with functional mitral regurgitation and mitral valve prolapse: implications for transcatheter mitral valve implantation. JACC Cardiovasc Imaging. 2016;9(3):269–80. https://doi.org/10.1016/j.jcmg.2015.08.022.

    Article  PubMed  Google Scholar 

  34. Carmo P, Andrade MJ, Aguiar C, Rodrigues R, Gouveia R, Silva JA. Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography. Cardiovascular Ultrasound. 2010;8(1):53. https://doi.org/10.1186/1476-7120-8-53.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hutchins GM, Moore GW, Skoog DK. The association of floppy mitral valve with disjunction of the mitral annulus fibrosus. N Engl J Med. 1986;314(9):535–40. https://doi.org/10.1056/NEJM198602273140902.

    Article  CAS  PubMed  Google Scholar 

  36. Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ. Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham study). Am J Cardiol. 1983;51(8):1375–8. https://doi.org/10.1016/0002-9149(83)90315-6.

    Article  CAS  PubMed  Google Scholar 

  37. Deluca G, Correale M, Ieva R, Del Salvatore B, Gramenzi S, Di Biase M. The incidence and clinical course of caseous calcification of the mitral annulus: a prospective echocardiographic study. J Am Soc Echocardiogr. 2008;21(7):828–33. https://doi.org/10.1016/j.echo.2007.12.004.

    Article  PubMed  Google Scholar 

  38. Plank F, Al-Hassan D, Nguyen G, Raju R, Wheeler M, Thompson C, et al. Caseous calcification of the mitral annulus. Cardiovasc Diagn Ther. 2013;3(2):E1–3. https://doi.org/10.3978/j.issn.2223-3652.2013.06.01.

    PubMed  PubMed Central  Google Scholar 

  39. Lutter G, Lozonschi L, Ebner A, Gallo S, Kall CM, Missov E, et al. First-in-human off-pump transcatheter mitral valve replacement. JACC Cardiovasc Interv. 2014;7(9):1077–8. https://doi.org/10.1016/j.jcin.2014.06.007.

    Article  PubMed  Google Scholar 

  40. •• Blanke P, Naoum C, Dvir D, Bapat V, Ong K, Muller D et al. Predicting LVOT Obstruction in Transcatheter Mitral Valve Implantation: Concept of the Neo-LVOT. JACC Cardiovasc Imaging. 2017;10(4):482–485. https://doi.org/10.1016/j.jcmg.2016.01.005. This manuscript introduced the concept of the Neo-LVOT which is being adopted as the anatomical measure relevant to risk assessment in TMVR.

  41. Blanke P, Dvir D, Naoum C, Cheung A, Ye J, Thériault-Lauzier P, et al. Prediction of fluoroscopic angulation and coronary sinus location by CT in the context of transcatheter mitral valve implantation. J Cardiovasc Comput Tomogr. 2015;9(3):183–92. https://doi.org/10.1016/j.jcct.2015.02.007.

    Article  PubMed  Google Scholar 

  42. Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312(2):162–70. https://doi.org/10.1001/jama.2014.7246.

    Article  CAS  PubMed  Google Scholar 

  43. Cheung A, Webb JG, Barbanti M, Freeman M, Binder RK, Thompson C, et al. 5-year experience with transcatheter transapical mitral valve-in-valve implantation for bioprosthetic valve dysfunction. J Am Coll Cardiol. 2013;61(17):1759–66. https://doi.org/10.1016/j.jacc.2013.01.058.

    Article  PubMed  Google Scholar 

  44. • Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: results from the first multicenter global registry. JACC Cardiovasc Interv. 2016;9(13):1361–71. https://doi.org/10.1016/j.jcin.2016.04.022. This is the first multicenter report discussing the valve in MAC procedure.

    Article  PubMed  Google Scholar 

  45. •• Pache G, Schoechlin S, Blanke P, Dorfs S, Jander N, Arepalli CD, et al. Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. Eur Heart J. 2015;37(28):2263–71. https://doi.org/10.1093/eurheartj/ehv526. This important manuscript introduced the concept of HALT to the clinical and interventional cardiology community.

    Article  PubMed  Google Scholar 

  46. Yanagisawa R, Hayashida K, Yamada Y, Tanaka M, Fumiaki Y, Inohara T, et al. Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVR. J Am Coll Cardiol Img. 2017;10(1):1–11.

    Article  Google Scholar 

  47. Soon J, Pibarot P, Blanke P, Ohana M, Leipsic J. Multimodality Imaging For Planning And Follow-Up Of TAVR. Can J Cardiol. 2017;33(9):1110–1123. https://doi.org/10.1016/j.cjca.2017.03.024

  48. Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of cardiovascular computed tomography guidelines committee: endorsed by the north American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2016;10(6):435–49. https://doi.org/10.1016/j.jcct.2016.10.002.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, Canada

    Rominder Grover, Mickael Ohana, Chesnal Dey Arepalli, Stephanie L. Sellers, John Mooney, Shaw-Hua Kueh, Ung Kim, Philipp Blanke & Jonathon A. Leipsic

  2. Centre for Heart Lung Innovation, St Paul’s Hospital and University of British Columbia, Vancouver, Canada

    Stephanie L. Sellers & Jonathon A. Leipsic

  3. Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada

    Jonathon A. Leipsic

  4. Department of Radiology, St. Paul’s Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada

    Jonathon A. Leipsic

Authors
  1. Rominder Grover
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mickael Ohana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chesnal Dey Arepalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie L. Sellers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Mooney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shaw-Hua Kueh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philipp Blanke
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jonathon A. Leipsic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathon A. Leipsic.

Ethics declarations

Conflict of Interest

Rominder Grover, Mickael Ohana, Chesnal Dey Arepalli, Stephanie L. Sellers, John Mooney, Shaw-Hua Kueh and Ung Kim declare that they have no conflict of interest.

Jonathon A. Leipsic is a consultant to Heartflow, Circle CVI, and Edwards Lifesciences. He provides Institutional Core Lab Support to Edwards Lifesciences, Neovasc, Tendyne, Ancora, Medtronic, and LASSO; and he has stock options in Heartflow, PI Cardia, and Circle CVI.

Philipp Blanke has received honoraria from HeartFlow, Edwards Lifesciences, Tendyne Holdings, and Circle Imaging. And he provides Institutional corelab services to: Edwards Lifesciences, Medtronic, Tendyne, and Neovasc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Cardiac PET, CT, and MRI

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grover, R., Ohana, M., Arepalli, C.D. et al. Role of MDCT Imaging in Planning Mitral Valve Intervention. Curr Cardiol Rep 20, 16 (2018). https://doi.org/10.1007/s11886-018-0960-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-018-0960-4

Keywords

Search

Navigation