Mitral Valve Imaging with CT for Transcatheter Interventions

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 1.50
Procedures: 1.50
Hemodynamics, Calculations, and Percutaneous Intervention: 1.50

Computed Tomography: 1.75
Image Production: 0.25
Image Formation: 0.25
Procedures: 1.50
Neck and Chest: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Thoracic Section: 1.50

Outline

1. Introduction
2. Essential Anatomy of the Mitral Valve
   1. Annulus
   2. Leaflets
   3. Subvalvular Apparatus
3. State of Technology in TMV Intervention
4. Imaging Assessment of the Mitral Valve
   1. Quantification of Mitral Regurgitation
   2. Mechanism of Mitral Regurgitation
   3. Annular Sizing
   4. Landing Zone Characterization
   5. LVOT Obstruction Assessment
   6. Predicting Fluoroscopic Angulations
   7. Apex Localization and Septal Puncture
5. Additional Information
6. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the percentage of the population, over 75 years of age, who are affected by mitral valve disease
2. categorize the causes of mitral regurgitation
3. identify the most common cause of mitral valve stenosis
4. describe the position of the mitral valve
5. identify the components of the mitral valve apparatus
6. describe the trigones of the annulus
7. discuss the importance of identifying the aortomitral continuity
8. describe the shape of the leaflets of the mitral valves
9. discuss CT techniques to enhance the visualization of the scallops of the mitral valve leaflets
10. describe the implications to the patient’s heart function from loss of the papillary chordal complex
11. identify the transcatheter techniques to repair the mitral valve
12. recognize the benefits of mitral valve repair
13. identify the modalities used in imaging mitral valve regurgitation
14. describe the limitation of 2D echocardiography in the quantification of the effective regurgitant orifice area
15. identify MRI sequences and their use in mitral valve regurgitation quantification
16. identify MRI quantification methods to calculate mitral regurgitation
17. identify how mitral regurgitation is calculated on CT
18. discuss the uses of 3D echocardiography in the visualization of the mechanism of mitral valve regurgitation
19. identify the structure which should trigger the CT contrast enhanced acquisition of the heart for mitral valve annulus assessment
20. determine the anatomy which should be used in post-processing of the mitral valve annulus
21. identify the required measurements of the mitral valve annulus
22. describe how primary mitral valve disease changes the shape of the annulus
23. discuss the requirements of transcatheter devices used to treat mitral valve stenosis
24. identify the factors which can cause LVOT obstruction after TMVR
25. identify the anatomy of the neo-LVOT
26. identify patients who are at risk of LVOT obstruction
27. discuss the cardiac imaging phase in which neo-LVOT calculations should be performed to give the most conservative data
28. identify the lines used to determine the optimal fluoroscopic angles for the coaxial deployment of the TMVR device
29. describe the use of hybrid imaging during TMVR procedures
30. identify the optimum approach to the mitral annulus for TMV procedures
31. discuss how CT can be used to determine the proper access point for TMV procedures
32. identify patients who are candidates for mitral valve surgical repair
33. identify the puncture site for TMV repair
34. identify essential quantitative elements which must be included in a preprocedural CT report for evaluation of mitral valve disease
35. identify pathologies which can pose challenges to TMV procedures