Imaging in Transcatheter Mitral Valve Replacement: State-of-Art Review

• Published in: Journal of clinical medicine Vol. 10; no. 24; p. 5973
• Main Authors: Barreiro-Perez, Manuel, Caneiro-Queija, Berenice, Puga, Luis, Gonzalez-Ferreiro, Rocío, Alarcon, Robert, Parada, Jose Antonio, Iñiguez-Romo, Andrés, Estevez-Loureiro, Rodrigo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 20-12-2021; MDPI
• Subjects: Calcification; Cardiovascular disease; Clinical medicine; Endocarditis; Etiology; Heart; Ostomy; Patients; Prostheses; Review; Surgery; Tomography; transcatheter mitral valve replacement; structural heart intervention; transoesophageal echocardiography; mitral regurgitation; cardiac computed tomography
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10245973

Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve surgery constitutes the first-line therapy; however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients. In patients with suitable anatomy, the transcatheter edge-to-edge mitral leaflet repair is the most frequently applied procedure. In non-reparable patients, transcatheter mitral valve replacement (TMVR) has appeared as a promising intervention. Thus, currently TMVR represents a new treatment option for inoperable or high-risk patients with degenerated or failed bioprosthetic valves (valve-in-valve); failed repairs, (valve-in-ring); inoperable or high-risk patients with native mitral valve anatomy, or those with severe annular calcifications, or valve-in-mitral annular calcification. The patient selection requires multimodality imaging pre-procedural planning to select the best approach and device, study the anatomical landing zone and assess the risk of left ventricular outflow tract obstruction. In the present review, we aimed to highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR.