CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR)

Abstract

Background Transcatheter mitral valve replacement (TMVR) is a treatment option for patients with therapy refractory high-grade mitral valve regurgitation and a high perioperative risk.

During TMVR, the mitral annulus cannot be visualized directly. Therefore, comprehensive pre-interventional planning and a precise visualization of the patient’s specific mitral valve anatomy, outflow tract anatomy and projected anchoring of the device are necessary.

Aim of this review-article is, to assess the role of pre-procedural computed tomography (CT) for TMVR-planning

Methods Screening and evaluation of relevant guidelines (European Society of Cardiology [ESC], American Heart Association [AHA/ACC]), meta-analyses and original research using the search terms “TVMR” or “TMVI” and “CT”. In addition to this, the authors included insight from their own clinical experience.

Results CT allows for accurate measurement of the mitral annulus with high special and adequate temporal resolution in all cardiac phases. Therefore, CT represents a valuable method for accurate prosthesis-sizing.

In addition to that, CT can provide information about the valvular- and outflow-tract-anatomy, mitral valve calcifications, configuration of the papillary muscles and of the left ventricle. Additionally, the interventional access-route may concomitantly be visualized.

Conclusion CT plays, in addition to echocardiographic imaging, a central role in pre-interventional assessment prior to TMVR. Especially the precise depiction of the left ventricular outflow tract (LVOT) provides relevant additional information, which is very difficult or not possible to be acquired in their entirety with other imaging modalities.

Key Points: 

• CT plays a central role in pre-interventional imaging for TMVR.

• CT-measurements allow for accurate prosthesis-sizing.

• CT provides valuable information about LVOT-anatomy, mitral calcifications and interventional access-route.

Citation Format

• Heiser L, Gohmann RF, Noack T et al. CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR). Fortschr Röntgenstr 2022; 194: 373 – 383

Key words

TMVI - TMVR - transcatheter mitral valve implantation - transcatheter mitral valve replacement - computed tomography - CT

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