Transcatheter Interventions for MR and Role of Multimodality Imaging
- Authors:
- Bax, JJ, Debonnaire P, Lancellotti P, et al.
- Citation:
- Transcatheter Interventions for Mitral Regurgitation: Multimodality Imaging for Patient Selection and Procedural Guidance. JACC Cardiovasc Imaging 2019;12:2029-2048.
The following are key points to remember from this review on transcatheter interventions for mitral regurgitation (MR) and multimodality imaging for patient selection and procedural guidance:
- Transcatheter mitral valve (MV) interventions for MR are feasible and may represent alternatives to medical and surgical therapy.
- Appropriate patient selection requires combinations of imaging techniques including computed tomography (CT) and echocardiography, while the procedure itself often requires integration of echocardiography and fluoroscopy imaging.
- Characterization of the etiology of MR and MV dysfunction by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) has good accuracy compared to surgical findings, and accuracy may improve by adding 3D TEE.
- TTE is the first-line imaging test to evaluate the severity and etiology of MR. If the TTE cannot fully assess the valve, TEE is recommended. Cardiac magnetic resonance imaging (CMR) may also be a useful test for evaluating MR severity.
- MR severity is usually graded qualitatively by color Doppler. The recommended quantitative approach is the flow convergence method, where the regurgitant volume and effective regurgitant orifice area can be calculated. The latter can have limited accuracy when there are multiple jets, or when jets are complex or eccentric.
- CMR can be useful to quantify MR severity by measuring regurgitant volume and fraction, although its ability to accurately assess the etiology of MR has not been well studied.
- Accurate measurements of left ventricular size and function is also important in treatment decisions for patients with MR, and can be assessed by echocardiography, CMR, and CT. There are advantages of 3D techniques over 2D imaging.
- MV function and anatomy can be assessed by CT, and its role is still under investigation. CT may be particularly helpful when evaluating the left ventricular outflow tract and estimating the effect of a transcatheter MV device on this region to assess for potential left ventricular outflow tract obstruction.
- Transcatheter MV interventions include a variety of approaches, including repairs that target the leaflets themselves with an edge-to-edge repair or with neo-chordae, therapies that target the annulus to reduce its size, and valve replacement systems. All of these interventions may include 2D/3D TTE and TEE as well as CT for the evaluation of patients, with procedural guidance using 2D/3D TEE and potentially fluoroscopy.
- Treatment of patients with severe MR is rapidly changing with new transcatheter MV interventions, and multimodality imaging plays a critical role in utilizing these therapies.
Keywords: Cardiac Surgical Procedures, Cardiology Interventions, Diagnostic Imaging, Echocardiography, Echocardiography, Transesophageal, Fluoroscopy, Heart Valve Diseases, Magnetic Resonance Imaging, Mitral Valve Insufficiency, Multimodal Imaging, Tomography, X-Ray Computed, Transcatheter Aortic Valve Replacement
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