Abstract
Transcatheter mitral valve interventions are an evolving and growing field in which multimodality cardiac imaging is essential for diagnosis, procedural planning, and intraprocedural guidance. Currently, transcatheter mitral valve-in-valve with a balloon-expandable valve is the only form of transcatheter mitral valve replacement (TMVR) approved by the FDA, but valve-in-ring and valve-in-mitral annular calcification interventions are increasingly being performed. Additionally, there are several devices under investigation for implantation in a native annulus. Paravalvular leak (PVL) is a known complication of surgical or transcatheter valve implantation, where regurgitant flow occurs between the prosthetic sewing ring and the native mitral annulus. We sought to describe the role and applications of multimodality cardiac imaging for TMVR, and PVL closure, including the use of Cardiovascular Computed Tomography Angiography and 3-Dimensional Transesophageal Echocardiography for diagnosis, prosthetic valve evaluation, pre-procedural planning, and intraprocedural guidance, as well as evolving technologies such as fusion imaging and 3D printing.
Highlights
With the approval of transcatheter mitral valve-in-valve therapy by the United States Food and Drug Administration (FDA) in 2017 and several devices under clinical investigation for native mitral disease, transcatheter mitral interventions are the rapidly evolving frontier after the unabated success of transcatheter aortic valve replacement
Valve-in-valve (ViV), valve-in-ring (ViR), and valve-in-mitral annular calcification (ViMAC) transcatheter mitral valve replacement (TMVR) have emerged as increasingly valuable percutaneous alternatives to surgical therapy in this population
Once the closure device is across the defect, an attempt should be made to visualize the ventricular disc of the device as it comes against the prosthetic sewing ring, followed by the center column and the atrial disc (Figures 11H,I)
Summary
Planning and Guidance of Transcatheter Mitral Valve Replacement and Mitral Paravalvular. Transcatheter mitral valve interventions are an evolving and growing field in which multimodality cardiac imaging is essential for diagnosis, procedural planning, and intraprocedural guidance. There are several devices under investigation for implantation in a native annulus. Paravalvular leak (PVL) is a known complication of surgical or transcatheter valve implantation, where regurgitant flow occurs between the prosthetic sewing ring and the native mitral annulus. We sought to describe the role and applications of multimodality cardiac imaging for TMVR, and PVL closure, including the use of Cardiovascular Computed Tomography Angiography and 3-Dimensional Transesophageal Echocardiography for diagnosis, prosthetic valve evaluation, pre-procedural planning, and intraprocedural guidance, as well as evolving technologies such as fusion imaging and 3D printing
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