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Review
. 2022 Apr 4;9(4):108.
doi: 10.3390/jcdd9040108.

The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation

Marco Guglielmo  1 , Chiara Rovera  1 , Mark G Rabbat  2   3 , Gianluca Pontone  1
Affiliations
Review

The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation

Marco Guglielmo et al. J Cardiovasc Dev Dis. .

Abstract

Cardiac magnetic resonance (CMR) imaging is a well-set diagnostic technique for assessment of valvular heart diseases and is gaining ground in current clinical practice. It provides high-quality images without the administration of ionizing radiation and occasionally without the need of contrast agents. It offers the unique possibility of a comprehensive stand-alone assessment of the heart including biventricular function, left ventricle remodeling, myocardial fibrosis, and associated valvulopathies. CMR is the recognized reference for the quantification of ventricular volumes, mass, and function. A particular strength is the ability to quantify flow, especially with new techniques which allow accurate measurement of stenosis and regurgitation. Furthermore, tissue mapping enables the visualization and quantification of structural changes in the myocardium. In this way, CMR has the potential to yield important prognostic information predicting those patients who will progress to surgery and impact outcomes. In this review, the fundamentals of CMR in assessment of aortic valve diseases (AVD) are described, together with its strengths and weaknesses. This state-of-the-art review provides an updated overview of CMR potentials in all AVD issues, including valve anatomy, flow quantification, ventricular volumes and function, and tissue characterization.

Keywords: aortic regurgitation; aortic stenosis; aortic valve; cardiovascular magnetic resonance; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CMR evaluation of aortic stenosis: (A) planimetry of aortic valve (red line); (B) measurement of IVS (red line) and PW thickening (green line), showing asymmetric hypertrophy of the IVS; (C) assessment of thoracic aorta (asterisk); (D) mid-wall LGE of the IVS. CMR: cardiovascular magnetic resonance; IVS: interventricular septum; PW: left ventricle posterolateral wall; LGE: late gadolinium enhancement.
Figure 2
Figure 2
CMR SSFP sequences for AR assessment: (A) identification of regurgitant flow as signal void artifact; (B) assessment of aortic root; (C) aortic valve morphology evaluation; (D) left ventricle short-axis view. CMR: cardiovascular magnetic resonance; SSFP: steady-state free precession; AR: aortic regurgitation.
Figure 3
Figure 3
Aortic regurgitant flow quantification: (A) phase contrast imaging; (B) 4D flow technique.
Figure 4
Figure 4
Approach for measurement of aortic annular size, aortic leaflet size, and coronary artery ostia using CMR. Assessment of aortic annulus (A–C): aortic annulus is defined as a virtual ring formed by joining the basal attachments of aortic valve leaflets. For aortic annulus, maximum diameter, minimum diameter, and area (white dot line) were traced in an orthogonal plane on the center line of the aorta achieved in oblique coronal and oblique sagittal views. Evaluation of leaflet length (D): the distance between the basal attachment and the apex of the leaflets (black dot line) is calculated. Measurement of coronary ostia height (E–G): a coronal view (E) and 2 short axes of the ascending aorta (F) and (G) at the level of the left main coronary ostium (red line) and aortic annulus (blue line) are obtained. The distance between these 2 lines is the coronary ostium height (adapted with permission from Elsevier [73], order number 5240390143830).
See this image and copyright information in PMC

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