Imaging the mitral valve: a primer for the interventional surgeon

Area of Science:

• Cardiovascular Medicine
• Medical Imaging

Background:

• Transcatheter mitral valve interventions (TMVI) offer alternatives to surgery for severe mitral regurgitation (MR).
• High-quality cardiac imaging is vital for patient selection and guiding TMVI procedures.
• Understanding mitral valve anatomy and regurgitation mechanisms is key for successful treatment.

Purpose of the Study:

• To highlight the essential role of multi-modality cardiac imaging in TMVI.
• To discuss the application of various imaging modalities in preprocedural planning and procedural guidance for TMVI.
• To emphasize the evolving importance of imaging in percutaneous mitral valve repair (MVr) and replacement.

Main Methods:

• Review of current multi-modality cardiac imaging techniques including echocardiography (transthoracic and transesophageal), CT, and CMR.
• Assessment of imaging's role in evaluating MR pathophysiology, valve anatomy, and severity.
• Discussion of imaging guidance for specific TMVI device-based procedures targeting leaflets, annulus, or chordae.

Main Results:

• Echocardiography (TEE) and other imaging modalities are crucial for diagnosing mitral valve disease and planning TMVI.
• Imaging facilitates assessment of spatial relationships between the mitral valve complex and surrounding structures (coronary sinus, coronary artery, LV outflow tract).
• TEE and fluoroscopy are primary guidance tools for current TMVI procedures.

Conclusions:

• Cardiac imaging is indispensable for the success of TMVI, from patient selection to procedural guidance.
• The interventional surgeon must possess a comprehensive understanding of diverse imaging modalities and novel concepts for assessing valvular function.
• As TMVI technologies advance, the role of cardiac imaging will continue to expand in percutaneous mitral valve repair and replacement.