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Review
. 2021 Jan;14(1):112-127.
doi: 10.1016/j.jcmg.2020.11.021.

Imaging for Native Mitral Valve Surgical and Transcatheter Interventions

Livia L Gheorghe  1 , Sara Mobasseri  2 , Eustachio Agricola  3 , Dee Dee Wang  4 , Federico Milla  2 , Martin Swaans  5 , Dimosthenis Pandis  6 , David H Adams  6 , Pradeep Yadav  2 , Horst Sievert  7 , Gorav Ailawadi  8 , Paul Sorajja  9
Affiliations
Free article
Review

Imaging for Native Mitral Valve Surgical and Transcatheter Interventions

Livia L Gheorghe et al. JACC Cardiovasc Imaging. 2021 Jan.
Free article

Abstract

There has been rapid progress in transcatheter therapies for mitral regurgitation. These developments have elevated the need for the imager to have a core understanding of the functional mitral valve anatomy. Pre- and intraoperative echocardiography for surgical mitral valve repair for mitral regurgitation has defined contemporary interventional imaging in many ways. The central tenets of these principles apply to interventional imaging of transcatheter mitral valve interventions. However, the heightened emphasis on procedural planning and procedural imaging is one of the new challenges posed by transcatheter interventions. This need for accurate and reliable information has required the imager to be agnostic to the imaging modality. Cardiac computed tomography has become critical in procedural planning in this new paradigm. The expanded use of pre-procedural cardiac magnetic resonance to quantify mitral regurgitation and characterize the left ventricle is another illustration of this newer approach. Other illustrations of the new world of interventional imaging include the expanded use of 3-dimensional (3D) transesophageal echocardiography and real-time fusion of echocardiography and fluoroscopy images. Imaging data are also the basis for computational modeling, 3D printing, and artificial intelligence. These technologies are being increasingly explored to improve therapy selection and prediction of procedural outcomes. This review provides an update of the essentials in present interventional imaging for surgical and transcatheter interventions for mitral regurgitation.

Keywords: Barlow mitral valve; MitraClip; beating heart chordal implant; mitral regurgitation; mitral valve; mitral valve anatomy for interventions; transcatheter mitral valve interventions; transcatheter mitral valve repair; transcatheter mitral valve replacement.

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Conflict of interest statement

Author Disclosures Dr. Wang is a consultant for Edwards Lifesciences, Boston Scientific, and Materialise; receives research grant support from Boston Scientific assigned to employer Henry Ford Health system; and holds a patent on LVOT prediction modeling software assigned to Henry Ford Health System. Dr. Wang is a member of the CLASP IITR Steering Committee and of the PARADIGM Steering Committee. Dr. Swaans is a consultant and lecturer for Abbott Vascular, Boston Scientific, Philips Healthcare, and Bioventrix. Dr. Adams’ institution, the Icahn School of Medicine at Mount Sinai, receives royalty payments from Edwards Lifesciences and Medtronic for intellectual property related to development of valve repair rings; and is national co-principal investigator for Medtronic APOLLO FDA Pivotal Trial, the NeoChord ReChord FDA Pivotal Trial, the Medtronic CoreValve US Pivotal Trial, and the Abbott TRILUMINATE Pivotal Trial. Dr. Yadav is a proctor and speaker for Edwards Lifesciences; and a consultant for and holds stock in Shockwave Medical. Dr. Sievert has received honoraria, travel expenses, and consulting fees from e25,000; 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Append Medical, Axon, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Cardiac Success, Cardimed, Celonova, Corned B.V., Contego, CVRx, Dinova, Edwards Lifesciences, Endologix, Endomatic, Hemoteq, Hangzhou Nuomao Medtech, Holistick Medical, K2, Lifetech, Maquet Getinge Group, Medtronic, Makita, Occlutech, Recor, Renal Guard, Terumo, Trisol, Vascular Dynamics, Vectorious Medtech, Venus, Venock, and Vivasure Medical. Dr. Ailawadi is a consultant for Edwards Lifesciences, Abbott, Medtronic, WL Gore, Atricure, and Admedus. Dr. Sorajja is a consultant for Admedus, Abbott Structural, Boston Scientific, Evolution Medical, Half Moon Medical, Medtronic, TeleFlex, Edwards Lifesciences, Shifamed, WL Gore; and is a member of the EXPAND Steering Committee, WL Gore Pipeline Executive Committee, SUMMIT Steering Committee, TRILUMINATE Steering Committee, TRILUMINATE Eligibility Committee For Anatomy, G4 Adverse Leaflet Events Committee, Neovasc Executive Steering Committee; and is a national or global principal investigator for the TRILUMINATE Pivotal US Trial, the Tendyne MAC Pivotal Trial, and the Alt-FLOW Early Feasibility Study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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