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

Publikationsverlauf

Eingereicht: 30. Juli 2021

Angenommen: 09. November 2021

Artikel online veröffentlicht:
10. März 2022

• References

• 1 Nkomo VT. et al. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005-1011
• 2 Nishimura RA, Bonow RO. Percutaneous Repair of Secondary Mitral Regurgitation – A Tale of Two Trials. N Engl J Med 2018; 379: 2374-2376
• 3 Levine RA. et al. Mitral valve disease – morphology and mechanisms. Nat Rev Cardiol 2015; 12: 689-710
• 4 Delgado V. et al. Assessment of mitral valve anatomy and geometry with multislice computed tomography. JACC Cardiovasc Imaging 2009; 2: 556-565
• 5 Baumgartner H. et al. 2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Rev Esp Cardiol (Engl Ed) 2018; 71: 110
• 6 Noack T. et al. Transcatheter mitral valve repair: review of current techniques. Indian J Thorac Cardiovasc Surg 2020; 36 (Suppl. 01) 53-63
• 7 Yoon SH. et al. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings. J Am Coll Cardiol 2017; 70: 1121-1131
• 8 Binder RK, Webb JG. Percutaneous mitral and aortic paravalvular leak repair: indications, current application, and future directions. Curr Cardiol Rep 2013; 15: 342
• 9 Garbi M, Monaghan MJ. Quantitative mitral valve anatomy and pathology. Echo Res Pract 2015; 2: R63-R72
• 10 Ranganath P. et al. CT for Pre- and Postprocedural Evaluation of Transcatheter Mitral Valve Replacement. Radiographics 2020; 40: 1528-1553
• 11 Blanke P. 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: 459-467
• 12 Blanke P. et al. Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement: Establishing Consensus Among Modalities and Disciplines. JACC Cardiovasc Imaging 2015; 8: 1191-1208
• 13 Asgar AW. Sizing the Mitral Annulus: Is CT the Future?. JACC Cardiovasc Imaging 2016; 9: 281-282
• 14 Noack T. et al. Dynamic mitral valve geometry in patients with primary and secondary mitral regurgitation: implications for mitral valve repairdagger. Eur J Cardiothorac Surg 2019; 56: 983-992
• 15 Muller DWM. et al. Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation: A Global Feasibility Trial. J Am Coll Cardiol 2017; 69: 381-391
• 16 Bapat V. et al. Early Experience With New Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2018; 71: 12-21
• 17 Guerrero M. et al. 1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification. J Am Coll Cardiol 2018; 71: 1841-1853
• 18 Cheung A. Early experience of TIARA transcatheter mitral valve replacement system. Ann Cardiothorac Surg 2018; 7: 787-791
• 19 Guerrero M. et al. Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States: Data From the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2020; 13: e008425
• 20 Vahanian A, Urena M, Himbert D. Transcatheter Mitral Valve Replacement: The End of the Beginning?. J Am Coll Cardiol 2019; 73: 1261-1263
• 21 Sondergaard L. et al Transcatheter mitral valve implantation via transapical approach: an early experience. Eur J Cardiothorac Surg 2015; 48: 873-877 ; discussion 877–878
• 22 Cheung A. et al. Short-term results of transapical transcatheter mitral valve implantation for mitral regurgitation. J Am Coll Cardiol 2014; 64: 1814-1819
• 23 Regueiro A. et al. Transcatheter Mitral Valve Replacement: Insights From Early Clinical Experience and Future Challenges. J Am Coll Cardiol 2017; 69: 2175-2192
• 24 Urena M. et al. Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves: A Step-by-Step Approach. JACC Cardiovasc Interv 2017; 10: 1905-1919
• 25 Del Val D. et al. Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2019; 8: e013332
• 26 Leschka S. et al. Scan length adjustment of CT coronary angiography using the calcium scoring scan: effect on radiation dose. Am J Roentgenol 2010; 194: W272-W277
• 27 Gohmann RF. et al. Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-out Significant Coronary Artery Disease. J Clin Med 2020; 9: 1623
• 28 Seitz P, Gottschling S, Lücke C. et al. Pre-procedural high-pitch coronary CT angiography assessment of patients undergoing transcatheter aortic valve implantation (TAVI) without patient-specific adjustment: analysis of diagnostic performance. Clinical Radiology 2021; 76: 862.e29-862.e36
• 29 Blanke P. et al. Mitral Annular Evaluation With CT in the Context of Transcatheter Mitral Valve Replacement. JACC Cardiovasc Imaging 2015; 8: 612-615
• 30 Reid A. et al. Neo-LVOT and Transcatheter Mitral Valve Replacement: Expert Recommendations. JACC Cardiovasc Imaging 2021; 14: 854-866
• 31 Blanke P. et al. Predicting LVOT Obstruction in Transcatheter Mitral Valve Implantation: Concept of the Neo-LVOT. JACC Cardiovasc Imaging 2017; 10: 482-485
• 32 Naoum C. 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: 269-280
• 33 Faggioni L. et al. Preprocedural planning of transcatheter mitral valve interventions by multidetector CT: What the radiologist needs to know. Eur J Radiol Open 2018; 5: 131-140
• 34 Korn D, Desanctis RW, Sell S. Massive calcification of the mitral annulus. A clinicopathological study of fourteen cases. N Engl J Med 1962; 267: 900-909
• 35 Abramowitz Y. et al. Concomitant mitral annular calcification and severe aortic stenosis: prevalence, characteristics and outcome following transcatheter aortic valve replacement. Eur Heart J 2017; 38: 1194-1203
• 36 Guerrero M. et al. A Cardiac Computed Tomography-Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization. JACC Cardiovasc Imaging 2020; 13: 1945-1957
• 37 Capoulade R. et al. Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation. J Thorac Dis 2017; 9 (Suppl. 07) S640-S660