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You are here: Contents > 2018 > Volume 27 Number 2 March 2018 > MITRAL VALVE DISEASE > Importance of Cardiac Computed Tomography Preprocedural Planning for Transcatheter Mitral Valve-In-Valve and Mitral Valve-In-Ring Implantations

Importance of Cardiac Computed Tomography Preprocedural Planning for Transcatheter Mitral Valve-In-Valve and Mitral Valve-In-Ring Implantations

Anas Fares1,2, Mohamad Amer Alaiti1, Hiram G. Bezerra1, Basar Sareyyupoglu1, Benjamin Medalion1, Ahmad Alkhalil1, Emile Mehanna1, Sanjay Rajagopalan1, Daniel I. Simon1, Marco A. Costa1, Alan Markowitz1, Guilherme F. Attizzani1

1The Valve Center, University Hospitals Harrington Heart & Vascular Institute, and Division of Cardiovascular Medicine, Case Western Reserve University, Cleveland, Ohio, USA
2Electronic correspondence: Anas.Fares@UHhospitals.org

With the extensive advances in mitral valve surgery and subsequent improvements in survival, the chance for a later redo intervention has become greater. Considering the significant risk of redo mitral valve surgery, high morbidity and mortality, those patients will likely benefit substantially from minimally invasive approaches, especially percutaneous procedures (i.e., transcatheter mitral valve-in- valve [TMVIV] and mitral valve-in-ring [TMVIR]). Since these procedures are not performed under direct visualization, computed tomography (CT) preprocedural planning can play a crucial role to ensure optimal results while reducing potential complications. The study aim was to elucidate the utility of CT in that context, with special emphasis on specific points learned from clinical cases performed at the authors’ institution. Although the transcatheter new valve size is in theory determined by the mitral valve or ring previously implanted, CT shows that it can, in practical terms, provide further information that can affect size selection. Furthermore, the four-dimensional CT data shed insight into the feasibility of the TMVIV and TMVIR by predicting potential left ventricular outflow tract obstruction. Moreover, different CT post-processing techniques and applications allow the creation of a detailed roadmap for optimal positioning of the transcatheter new valves.

Video 1: Case #1: Pre-procedure echocardiogram.

Video 2: Case #1: Eight months post-procedure echocardiogram.

Video 3: Case #1: Two years post-procedure echocardiogram.

Video 4: Case #2: Pre-procedure echocardiogram.

Video 5: Case #2: Post procedure echocardiogram.

Video 6: Case #3: Three months pre-procedure echocardiogram.

Video 7: Case #3: Pre-procedure echocardiogram.

Video 8: Case #3: One year post-procedure echocardiogram.

Video 9: Previous valve annulus dynamic changes – visual assessment. Computed tomography en-face view cine of a Mosaic valve demonstrating dynamic changes through the cardiac cycle.

Video 10: Previous valve annulus dynamic changes - quantitative assessment. Computed tomography en-face view cine of a Mosaic valve demonstrating dynamic dimensional changes (lower arrow) through the cardiac cycle (upper arrow).

The Journal of Heart Valve Disease 2018;27:160-164


Importance of Cardiac Computed Tomography Preprocedural Planning for Transcatheter Mitral Valve-In-Valve and Mitral Valve-In-Ring Implantations

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