| Popis: |
Background: Transesophageal echocardiogram (TEE) is the gold-standard for diagnosis of degenerative mitral regurgitation (MR) and is used for guidance of transcatheter mitral valve repair (TMVr). However, TEE is an invasive diagnostic modality that requires anesthesia and esophageal intubation. Multi-detector computed tomographic angiography (MDCT) provides high resolution images and three dimensional (3D) reconstructions that allow for comprehensive assessment of complex mitral anatomy. We hypothesized that MDCT can yield similar information to 3D TEE relevant to TMVr, deferring the need for a preoperative TEE. Methods: Patients that underwent TMVr (or were evaluated for transcatheter mitral valve replacement) for degenerative MR were retrospectively analyzed from 2017 to 2019 at a single center. Patients were included in the analysis if preoperative MDCT was performed. Two experienced TEE and two MDCT readers, blinded to patient outcome and alternative imaging modality, analyzed the following characteristics: leaflet pathology (flail, degenerative, mixed), leaflet location (A1-3/P1-3), 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: Of the 87 patients, 22 had preoperative MDCT. MDCT was able to correctly identify the leaflet pathology in 77% (17/22). Eleven patients had a flail leaflet with 91% (10/11) identified on MDCT and MDCT correctly predicted the dysfunctional leaflet location in 95% (21/22). Measurements were not significantly different for MVA, flail width, commissural diameter, AP diameter, posterior leaflet length and leaflet thickness. However, measurements on MDCT were significantly overestimated for flail gap compared to TEE. Degree of MAC was similar in 91% (10/11) between imaging modalities. Conclusion: MDCT provides similar measurements to 3D TEE for preoperative TMVr planning. Further studies are required to establish novel imaging algorithms utilizing MDCT to reduce the need for preoperative TEE. |
