Utility of Multidetector Computed Tomographic Angiography as an Alternative to Transesophageal Echocardiogram for Preoperative Transcatheter Mitral Valve Repair Planning.
Mitral valve
Multidetector computed tomography
Transesophageal echocardiography
Journal
Journal of cardiovascular imaging
ISSN: 2586-7296
Titre abrégé: J Cardiovasc Imaging
Pays: Korea (South)
ID NLM: 101728106
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
30
03
2022
revised:
03
07
2022
accepted:
12
07
2022
entrez:
24
1
2023
pubmed:
25
1
2023
medline:
25
1
2023
Statut:
ppublish
Résumé
Three-dimensional (3D) transesophageal echocardiogram (TEE) is the gold standard for the diagnosis of degenerative mitral regurgitation (dMR) and preoperative planning for transcatheter mitral valve repair (TMVr). TEE is an invasive modality requiring anesthesia and esophageal intubation. The severe acute respiratory syndrome coronavirus 2 pandemic has limited the number of elective invasive procedures. Multi-detector computed tomographic angiography (MDCT) provides high-resolution images and 3D reconstructions to assess complex mitral anatomy. We hypothesized that MDCT would reveal similar information to TEE relevant to TMVr, thus deferring the need for a preoperative TEE in certain situations like during a pandemic. We retrospectively analyzed data on patients who underwent or were evaluated for TMVr for dMR with preoperative MDCT and TEE between 2017 and 2019. Two TEE and 2 MDCT readers, blinded to patient outcome, analyzed: leaflet pathology (flail, degenerative, mixed), leaflet location, mitral valve area (MVA), flail width/gap, anterior-posterior (AP) and commissural diameters, posterior leaflet length, leaflet thickness, presence of mitral valve cleft and degree of mitral annular calcification (MAC). A total of 22 (out of 87) patients had preoperative MDCT. MDCT correctly identified the leaflet pathology in 77% (17/22), flail leaflet in 91% (10/11), MAC degree in 91% (10/11) and the dysfunctional leaflet location in 95% (21/22) of patients. There were no differences in the measurements for MVA, flail width, commissural or AP diameter, posterior leaflet length, and leaflet thickness. MDCT overestimated the measurements of flail gap. For preoperative TMVr planning, MDCT provided similar measurements to TEE in our study.
Sections du résumé
BACKGROUND
BACKGROUND
Three-dimensional (3D) transesophageal echocardiogram (TEE) is the gold standard for the diagnosis of degenerative mitral regurgitation (dMR) and preoperative planning for transcatheter mitral valve repair (TMVr). TEE is an invasive modality requiring anesthesia and esophageal intubation. The severe acute respiratory syndrome coronavirus 2 pandemic has limited the number of elective invasive procedures. Multi-detector computed tomographic angiography (MDCT) provides high-resolution images and 3D reconstructions to assess complex mitral anatomy. We hypothesized that MDCT would reveal similar information to TEE relevant to TMVr, thus deferring the need for a preoperative TEE in certain situations like during a pandemic.
METHODS
METHODS
We retrospectively analyzed data on patients who underwent or were evaluated for TMVr for dMR with preoperative MDCT and TEE between 2017 and 2019. Two TEE and 2 MDCT readers, blinded to patient outcome, analyzed: leaflet pathology (flail, degenerative, mixed), leaflet location, mitral valve area (MVA), flail width/gap, anterior-posterior (AP) and commissural diameters, posterior leaflet length, leaflet thickness, presence of mitral valve cleft and degree of mitral annular calcification (MAC).
RESULTS
RESULTS
A total of 22 (out of 87) patients had preoperative MDCT. MDCT correctly identified the leaflet pathology in 77% (17/22), flail leaflet in 91% (10/11), MAC degree in 91% (10/11) and the dysfunctional leaflet location in 95% (21/22) of patients. There were no differences in the measurements for MVA, flail width, commissural or AP diameter, posterior leaflet length, and leaflet thickness. MDCT overestimated the measurements of flail gap.
CONCLUSIONS
CONCLUSIONS
For preoperative TMVr planning, MDCT provided similar measurements to TEE in our study.
Identifiants
pubmed: 36693340
pii: 31.18
doi: 10.4250/jcvi.2022.0043
pmc: PMC9880348
doi:
Types de publication
Journal Article
Langues
eng
Pagination
18-23Informations de copyright
Copyright © 2023 Korean Society of Echocardiography.
Déclaration de conflit d'intérêts
Chad A Kliger is a consultant and receives speaking honoraria from Edwards Lifescience and Medtronic. Luigi Pirelli is a consultant and receives speaking honoraria from Edwards Lifescience and Medtronic.
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