CT for Pre- and Postprocedural Evaluation of Transcatheter Mitral Valve Replacement

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter mitral valve replacement (TMVR) offers an alternative for high-risk patients with mitral valve disease.
• Current TMVR devices utilize diverse anchoring mechanisms and delivery approaches (transapical, transseptal).
• Transthoracic echocardiography is standard, but CT provides superior anatomical detail for complex cases.

Purpose of the Study:

• To highlight the indispensable role of CT in preprocedural planning and postprocedural follow-up for TMVR.
• To detail the specific applications of CT in evaluating mitral annulus anatomy and predicting procedural risks.
• To demonstrate CT's utility in assessing access routes and identifying potential TMVR complications.

Main Methods:

• Utilizing high-resolution CT for precise mitral annulus measurements (area, perimeter, distances).
• Performing virtual TMVR device placement to simulate the neo-left ventricular outflow tract (LVOT) and assess obstruction risk.
• Evaluating the landing zone, subvalvular apparatus, and adjacent structures (coronary sinus, left circumflex artery).
• Assessing chest wall and atrial septum for transapical and transseptal access, respectively.
• Employing CT for post-TMVR complication surveillance (LVOT obstruction, paravalvular leak, etc.).

Main Results:

• CT enables accurate measurement of the mitral annulus, crucial for device selection and sizing.
• Virtual device implantation predicts and helps mitigate the risk of TMVR-induced LVOT obstruction.
• CT effectively visualizes the relationship between the device and critical adjacent structures.
• CT guides optimal access site selection and identifies potential complications during follow-up.

Conclusions:

• CT is essential for comprehensive preprocedural planning in TMVR, enabling accurate anatomical assessment and risk prediction.
• CT facilitates optimal device selection, placement, and access planning, contributing to successful TMVR outcomes.
• Post-TMVR CT surveillance is vital for early detection and management of complications, enhancing patient safety.