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Review
. 2022 Oct 10;8(10):278.
doi: 10.3390/jimaging8100278.

Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation

Pietro Costantini  1 , Francesco Perone  2 , Agnese Siani  1 , Léon Groenhoff  1 , Giuseppe Muscogiuri  3   4 , Sandro Sironi  3   5 , Paolo Marra  3   5 , Serena Carriero  6 , Anna Giulia Pavon  7 , Marco Guglielmo  8
Affiliations
Review

Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation

Pietro Costantini et al. J Imaging. .

Abstract

The pulmonary valve (PV) is the least imaged among the heart valves. However, pulmonary regurgitation (PR) and pulmonary stenosis (PS) can occur in a variety of patients ranging from fetuses, newborns (e.g., tetralogy of Fallot) to adults (e.g., endocarditis, carcinoid syndrome, complications of operated tetralogy of Fallot). Due to their complexity, PR and PS are studied using multimodality imaging to assess their mechanism, severity, and hemodynamic consequences. Multimodality imaging is crucial to plan the correct management and to follow up patients with pulmonary valvulopathy. Echocardiography remains the first line methodology to assess patients with PR and PS, but the information obtained with this technique are often integrated with cardiac magnetic resonance (CMR) and computed tomography (CT). This state-of-the-art review aims to provide an updated overview of the usefulness, strengths, and limits of multimodality imaging in patients with PR and PS.

Keywords: CMR; CT; cardiac magnetic resonance; computed tomography; echocardiography; multimodality imaging; pulmonary regurgitation; pulmonary stenosis; pulmonary valve; valvulopathy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A–C) Assessment with transthoracic and transesophageal echocardiography of the pulmonary valve in a 50-year-old female patient: (A) Parasternal short-axis view with focus on pulmonary valve and pulmonary artery; (B) Subcostal view; (C) Mid-esophageal right ventricle inflow-outflow view. (D–F) Transthoracic echocardiography assessment of pulmonary regurgitation in a 60-year-old male patient: (D) Detection of pulmonary regurgitation by color flow Doppler imaging; (E) Continuous wave Doppler of pulmonary regurgitation flow; (F) Color M-mode demonstrates holodiastolic regurgitation jet.
Figure 2
Figure 2
Assessment of Pulmonary Stenosis with Cardiac Magnetic Resonance: 2 (A,B) 40-year-old female patient with Pulmonary Stenosis. Visualization of a systolic “jet” (hypointense signal as a result of phase loss of proton spin due to turbulent flow) in pulmonary artery (arrow) with a cine-SSFP sequence. (B) Phase contrast sequence, visualization of hypointense signal at the level of luminal narrowing; 2 (C) 19-year-old male patient with pulmonary regurgitation, identification of diastolic “jet” in the right ventricle outflow tract.
Figure 3
Figure 3
Assessment of Pulmonary Stenosis with CCT in a 15-year-old male patient: (A) Axial CT image with stenosis of the common trunk of the pulmonary artery; (B) CT reconstruction of the vessel using a dedicated post-processing software; (C) Angiographic image of percutaneous transluminal angioplasty (PTA) of the stenotic tract and (D) Angiographic image showing correct stent placement after PTA.
See this image and copyright information in PMC

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