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Capoulade R, Piriou N, Serfaty JM, Le Tourneau T. Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation. J Thorac Dis 2017; 9:S640-S660. [PMID: 28740719 PMCID: PMC5505945 DOI: 10.21037/jtd.2017.06.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022]
Abstract
Secondary mitral regurgitation (MR) is frequent valvular heart disease and conveys worse prognostic. Therapeutic surgical or percutaneous options are available in the context of severe symptomatic secondary MR, but the best approach to treat these patients remains unclear, given the lack of clear clinical evidence of benefit. A comprehensive evaluation of the mitral valve apparatus and the left ventricle (LV) has the ability to clearly define and characterize the disease, and thus determine the best option for the patient to improve its clinical outcomes, as well as quality of life and symptoms. The current report reviews the mitral valve (MV) anatomy, the underlying mechanisms associated with secondary MR, the related therapeutic options available, and finally the usefulness of a multimodality imaging approach for the planning of surgical or percutaneous mitral valve intervention.
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Affiliation(s)
- Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Nicolas Piriou
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
- Department of Nuclear Medicine, CHU Nantes, Nantes University, Nantes, France
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52
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Hwang JS, Lee H, Lee B, Lee SJ, Jou SS, Lim HK, Suh J. Estimation of Diastolic Filling Pressure with Cardiac CT in Comparison with Echocardiography Using Tissue Doppler Imaging: Determination of Optimal CT Reconstruction Parameters. Korean J Radiol 2017; 18:632-642. [PMID: 28670158 PMCID: PMC5447639 DOI: 10.3348/kjr.2017.18.4.632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/30/2016] [Indexed: 01/08/2023] Open
Abstract
Objective To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. Materials and Methods Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm2). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. Results For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′ ≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. Conclusion Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.
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Affiliation(s)
- Ji-Sun Hwang
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
| | - Bora Lee
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | | | - Sung Shick Jou
- Department of Radiology, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea
| | - Jon Suh
- Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
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53
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Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2017; 69:2175-2192. [DOI: 10.1016/j.jacc.2017.02.045] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/12/2017] [Accepted: 02/12/2017] [Indexed: 11/23/2022]
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Ivanov NA, Green DB, Guy TS. Integrate imaging approach for minimally invasive and robotic procedures. J Thorac Dis 2017; 9:S264-S270. [PMID: 28540069 DOI: 10.21037/jtd.2017.03.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the past two decades, robotic and minimally invasive cardiac surgery has been continuously refined and is currently an alternative to traditional open-heart surgery for some patients. The parallel evolution of imaging modalities has made robotic surgery safer and more efficient. Here, we review the pre- and post-operative use of computed tomography (CT) in minimally invasive and robotic cardiac procedures.
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Affiliation(s)
- Nikolay A Ivanov
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Daniel B Green
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - T Sloane Guy
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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55
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Cocchia R, D’Andrea A, Conte M, Cavallaro M, Riegler L, Citro R, Sirignano C, Imbriaco M, Cappelli M, Gregorio G, Calabrò R, Bossone E. Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach. World J Cardiol 2017; 9:212-229. [PMID: 28400918 PMCID: PMC5368671 DOI: 10.4330/wjc.v9.i3.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/15/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.
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56
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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Bozkurt S, Bozkurt S. In-silico evaluation of left ventricular unloading under varying speed continuous flow left ventricular assist device support. Biocybern Biomed Eng 2017. [DOI: 10.1016/j.bbe.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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58
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Mejean S, Bouvier E, Bataille V, Seknadji P, Fourchy D, Tabet JY, Lairez O, Cormier B. Mitral Annular Calcium and Mitral Stenosis Determined by Multidetector Computed Tomography in Patients Referred for Aortic Stenosis. Am J Cardiol 2016; 118:1251-1257. [PMID: 27567138 DOI: 10.1016/j.amjcard.2016.07.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
Mitral annular calcium (MAC) is a common finding in older patients referred for transcatheter aortic valve implantation (TAVI). Multidetector computed tomography (MDCT) allows fine quantification of the calcific deposits. Our objective was to estimate the prevalence of MAC and associated mitral stenosis (MS) in patients referred for TAVI using MDCT. A cohort of 346 consecutive patients referred for TAVI evaluation was screened by MDCT for MAC: 174 had MAC (50%). Of these patients, 165 patients (95%) had mitral valve area (MVA) assessable by MDCT planimetry (age 83.8 ± 5.9 years). Median mitral calcium volume and MVA were 545 mm3 (193 to 1,253 mm3) and 234 mm2 (187 to 297 mm2), respectively. The MS was very severe, severe, and moderate in 2%, 22%, and 10% patients, respectively. By multivariate analysis, MVA was independently correlated to mitral calcium volume, aortic annular area, and some specific patterns of mitral leaflet calcium. Based on these findings, a formula was elaborated to predict the presence of a significant MS. In conclusion, MDCT allows detailed assessment of MAC in TAVI populations, demonstrating a high prevalence. Mitral analysis should become routine during MDCT screening before TAVI as it may alter therapeutic strategy.
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Thériault-Lauzier P, Mylotte D, Dorfmeister M, Spaziano M, Andalib A, Mamane S, Chetrit M, Blanke P, Cecere R, Buithieu J, Martucci G, Tchetche D, Modine T, van Mieghem N, Lange R, Windecker S, Bilodeau L, Leipsic J, Piazza N. Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability. EUROINTERVENTION 2016; 12:e1011-e1020. [DOI: 10.4244/eijy15m11_09] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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60
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Preprocedural Computed Tomography Evaluation for Minimally Invasive Mitral Valve Surgery: What the Surgeon Needs to Know. J Thorac Imaging 2016; 30:386-96. [PMID: 26258601 DOI: 10.1097/rti.0000000000000170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The proven success of endoscopic and videoscopic surgery combined with recent advancements in telemanipulation has made the performance of minimally invasive cardiac surgery a clinical reality during the past decade. A complete understanding of the basic concepts of minimally invasive surgery and the recent advancements in peripheral cardiopulmonary bypass techniques help the cardiac imager to provide a clinically meaningful interpretation for the surgical team. In this article we present an overview of minimally invasive mitral valve surgery and the fundamentals of preprocedural computed tomography angiography imaging and highlight the usefulness of cardiac computed tomography as a supplementary tool to echocardiography.
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61
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Abdelghani M, Spitzer E, Soliman OI, Beitzke D, Laggner R, Cavalcante R, Tateishi H, Campos CM, Verstraeten L, Sotomi Y, Tenekecioglu E, Onuma Y, Tijssen JG, de Winter RJ, Maisano F, Serruys PW. A simplified and reproducible method to size the mitral annulus: implications for transcatheter mitral valve replacement. Eur Heart J Cardiovasc Imaging 2016; 18:697-706. [DOI: 10.1093/ehjci/jew132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/01/2016] [Indexed: 01/02/2023] Open
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62
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Natarajan N, Patel P, Bartel T, Kapadia S, Navia J, Stewart W, Tuzcu EM, Schoenhagen P. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovasc Diagn Ther 2016; 6:144-59. [PMID: 27054104 DOI: 10.21037/cdt.2016.02.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR.
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Affiliation(s)
- Navin Natarajan
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Parag Patel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Thomas Bartel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Samir Kapadia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Jose Navia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - William Stewart
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - E Murat Tuzcu
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Paul Schoenhagen
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
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63
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64
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Naoum C, Leipsic J, Cheung A, Ye J, Bilbey N, Mak G, Berger A, Dvir D, Arepalli C, Grewal J, Muller D, Murphy D, Hague C, Piazza N, Webb J, Blanke P. Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse. JACC Cardiovasc Imaging 2016; 9:269-80. [DOI: 10.1016/j.jcmg.2015.08.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 02/03/2023]
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65
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Li CH, Arzamendi D, Carreras F. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation. ACTA ACUST UNITED AC 2016; 69:421-36. [PMID: 26926991 DOI: 10.1016/j.rec.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures.
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Affiliation(s)
- Chi-Hion Li
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Dabit Arzamendi
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Carreras
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Wunderlich NC, Küx H, Kreidel F, Birkemeyer R, Siegel RJ. The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist. Interv Cardiol 2016; 11:135-139. [PMID: 29588721 DOI: 10.15420/icr.2016:12:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Percutaneous interventions in structural heart diseases are emerging rapidly. The variety of novel percutaneous treatment approaches and the increasing complexity of interventional procedures are associated with new challenges and demands on the imaging specialist. Standard catheterisation laboratory imaging modalities such as fluoroscopy and contrast ventriculography provide inadequate visualisation of the soft tissue or three-dimensional delineation of the heart. Consequently, additional advanced imaging technology is needed to diagnose and precisely identify structural heart diseases, to properly select patients for specific interventions and to support fluoroscopy in guiding procedures. As imaging expertise constitutes a key factor in the decision-making process and in the management of patients with structural heart disease, the sub-speciality of interventional imaging will likely develop out of an increased need for high-quality imaging.
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Affiliation(s)
| | - Harald Küx
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Felix Kreidel
- Department of Cardiology, Asklepios Klinik, St Georg Hospital, Hamburg, Germany
| | | | - Robert J Siegel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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67
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Taramasso M, Candreva A, Pozzoli A, Guidotti A, Gaemperli O, Nietlispach F, Barthelmes J, Emmert MY, Weber A, Benussi S, Alfieri O, Maisano F. Current challenges in interventional mitral valve treatment. J Thorac Dis 2015; 7:1536-42. [PMID: 26543599 DOI: 10.3978/j.issn.2072-1439.2015.04.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2022]
Abstract
Transcatheter mitral valve therapies have emerged as an alternative option in high surgical risk or inoperable patients with severe and symptomatic mitral regurgitation (MR). As multiple technologies and different approaches will become available in the field of mitral valve interventions, different challenges are emerging, both patient- (clinical challenges) and procedure-related (technical challenges). This review will briefly explore the current open challenges in the evolving fields of interventional mitral valve treatment.
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Affiliation(s)
- Maurizio Taramasso
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Alessandro Candreva
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Alberto Pozzoli
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Andrea Guidotti
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Oliver Gaemperli
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Fabian Nietlispach
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Jens Barthelmes
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Maximilian Y Emmert
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Alberto Weber
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Stefano Benussi
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Ottavio Alfieri
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Francesco Maisano
- 1 Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zurich, Switzerland ; 2 San Raffaele University Hospital, Milan, Italy ; 3 Klinik für Kardiologie, UniversitätsSpital Zürich, Zurich, Switzerland
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Tam CC, Fares A, Alaiti A, Shaikh K, Ince H, Erglis A, Bezerra HG, Abraham WT, Costa MA, Attizzani GF. Cardiac computed tomography assessment of the near term impact of percutaneous ventricular restoration therapy (parachute(®) ) on mitral valve geometry. Catheter Cardiovasc Interv 2015; 88:E45-51. [PMID: 26526037 DOI: 10.1002/ccd.26291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/24/2015] [Accepted: 10/02/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of current study is to assess the near term impact of percutaneous ventricular restoration therapy (PVR), Parachute(®) on mitral valve (MV) geometry by cardiac computed tomography (CCT). BACKGROUND Recent data demonstrates the feasibility of PVR for treatment of post anterior myocardial infarction (MI) heart failure. Little is known, however, about the interaction of the device and left ventricular structures, particularly the MV apparatus. METHODS This is a retrospective Core Laboratory analysis of Parachute Trials' CCT data. Patients with paired (before and after Parachute implant) CCT acquisitions were included into analysis. MV geometric parameters were measured. RESULTS Thirty-three patients were included in the analysis. The mean time of follow-up CCT post procedure was 188 ± 52 days. There were significant reduction in tenting height (A1P1: -1.70 ± 1.89 mm, -17.40 ± 20.20%; A2P2: -1.43 ± 1.89 mm, -12.10 ± 15.00%; A3P3: -1.54 ± 1.58 mm, -15.50 ± 15.20%, P < 0.001), tenting volume (-0.93 ± 0.60 mm3, -22.00 ± 11.40%, P < 0.001), systolic interpapillary muscle distance (-2.22 ± 2.11 mm, -7.51 ± 7.23%, P < 0.001) and diastolic interpapillary muscle distance (-3.14 ± 2.20 mm, -8.46 ± 5.73%, P < 0.001) post PVR. CONCLUSIONS In post anterior MI heart failure patients, PVR has favorable near term impact on MV geometry as assessed by CCT. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Chor Cheung Tam
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Anas Fares
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Amer Alaiti
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Kashif Shaikh
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum Im Friedrichshain Und Am Urban, Berlin, Germany.,Rostock University Medical Center, Rostock, Germany
| | - Andrejs Erglis
- Institute of Cardiology, University of Latvia, Pauls Stradins Clinical University Hospita, Riga, Latvia
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - William T Abraham
- Division of Cardiovascular Medicine, the Ohio State University, Columbus, Ohio
| | - Marco A Costa
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
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Suh YJ, Chang BC, Im DJ, Kim YJ, Hong YJ, Hong GR, Kim YJ. Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types. J Thorac Cardiovasc Surg 2015; 150:1082-90. [DOI: 10.1016/j.jtcvs.2015.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/25/2015] [Accepted: 07/03/2015] [Indexed: 01/20/2023]
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72
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Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement. JACC Cardiovasc Imaging 2015; 8:1191-1208. [DOI: 10.1016/j.jcmg.2015.08.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
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73
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Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles. Eur Heart J 2015; 36:1851-77. [DOI: 10.1093/eurheartj/ehv281] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/21/2015] [Indexed: 12/28/2022] Open
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Garbi M, Monaghan MJ. Quantitative mitral valve anatomy and pathology. Echo Res Pract 2015; 2:R63-72. [PMID: 26693344 PMCID: PMC4676476 DOI: 10.1530/erp-15-0008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/07/2015] [Indexed: 11/08/2022] Open
Abstract
Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications.
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Affiliation(s)
- Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust , London , UK
| | - Mark J Monaghan
- King's Health Partners, King's College Hospital NHS Foundation Trust , London , UK
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75
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Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 1: Clinical Trial Design Principles. J Am Coll Cardiol 2015; 66:278-307. [DOI: 10.1016/j.jacc.2015.05.046] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 01/22/2023]
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76
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Zhang L, Qiu J, Yu L, Chen S, Sun K, Yao L. Quantitative Assessment of Mitral Apparatus Geometry Using Dual-Source Computed Tomography in Mitral Regurgitation. Int Heart J 2015; 56:408-14. [PMID: 26104175 DOI: 10.1536/ihj.14-337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To quantitatively assess the geometric changes in mitral valve apparatus in mitral regurgitation (MR) by dualsource computed tomography (DSCT) and to analyze its impact on MR.The study subjects consisted of 20 controls, 20 patients with mild MR, and 30 patients with moderate to severe MR, all of whom underwent DSCT. The geometric parameters of the mitral valve were measured by CT and compared among the 3 groups. The correlations between DSCT measurements and MR severity were also analyzed.As regurgitation worsened, our results showed progressive enlargements of the mitral annular area, anteroposterior diameter, and mitral valve tenting area at the central level. Moreover, a higher mitral valve sphericity index and longer distance between the heads of the papillary muscles reflected a more outward displacement of the papillary muscles. The mitral annular area and tenting area at the central level had strong correlations with regurgitation severity.DSCT is available to quantitatively assess mitral valve morphology and provide additional information regarding its geometry. The mitral annular area and tenting area at the central level were the strongest determinants of MR severity.
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Affiliation(s)
- Lingxuezi Zhang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University
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Renapurkar RD, El-Sherief AH, Prieto L, Kapadia SR, Schoenhagen P. Transcatheter Structural Cardiac Intervention: A Radiology Perspective. AJR Am J Roentgenol 2015; 204:W648-W662. [DOI: 10.2214/ajr.14.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Rahul D. Renapurkar
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed H. El-Sherief
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Lourdes Prieto
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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78
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Assessment of Mitral Valve Disease: A Review of Imaging Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:390. [DOI: 10.1007/s11936-015-0390-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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79
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CT of Cardiac Valves. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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80
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Secondary Mitral Regurgitation in Heart Failure. J Am Coll Cardiol 2015; 65:1231-1248. [DOI: 10.1016/j.jacc.2015.02.009] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 12/23/2022]
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81
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Thériault-Lauzier P, Spaziano M, Vaquerizo B, Buithieu J, Martucci G, Piazza N. Computed Tomography for Structural Heart Disease and Interventions. Interv Cardiol 2015; 10:149-154. [PMID: 29588693 DOI: 10.15420/icr.2015.10.03.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Transcatheter cardiac interventions are a fast evolving field. The past decade has seen the development of transcatheter aortic valve replacement, transcatheter mitral valve repair and replacement, septal defect closure devices and left atrial appendage closure devices for thromboprophylaxis. More than ever, medical imaging is taking a central role in the care of patients with structural heart disease. In this review article we outline the use of MSCT as a tool for diagnosis of structural heart interventions, as well as patient selection, pre-procedural planning, device sizing and post-procedural assessment. We focus on procedures targeting the aortic valve, the mitral valve, the inter-atrial septum and the left atrial appendage.
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Affiliation(s)
| | - Marco Spaziano
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Jean Buithieu
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada.,German Heart Centre Munich, Munich, Germany
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83
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Dudzinski DM, Hung J. Echocardiographic assessment of ischemic mitral regurgitation. Cardiovasc Ultrasound 2014; 12:46. [PMID: 25416497 PMCID: PMC4277822 DOI: 10.1186/1476-7120-12-46] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Ischemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Echocardiographic diagnosis and assessment of ischemic mitral regurgitation are critical to gauge its adverse effects on prognosis and to attempt to tailor rational treatment strategy. There is no single approach to the echocardiographic assessment of ischemic mitral regurgitation: standard echocardiographic measures of mitral regurgitation severity and of LV dysfunction are complemented by assessments of displacement of the papillary muscles and quantitative indices of mitral valve deformation. Development of novel approaches to understand mitral valve geometry by echocardiography may improve understanding of the mechanism, clinical trajectory, and reparability of ischemic mitral regurgitation.
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Affiliation(s)
| | - Judy Hung
- Echocardiography Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA.
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84
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Sanz J, Weinsaft JW. Ischemic mitral regurgitation: is mitral valve physiology moving from global to local? J Am Coll Cardiol 2014; 64:1880-2. [PMID: 25444140 DOI: 10.1016/j.jacc.2014.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jonathan W Weinsaft
- Department of Medicine, Greenberg Cardiology Division, Weill Cornell Medical College, New York, New York
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85
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Blanke P, Dvir D, Cheung A, Ye J, Levine RA, Precious B, Berger A, Stub D, Hague C, Murphy D, Thompson C, Munt B, Moss R, Boone R, Wood D, Pache G, Webb J, Leipsic J. A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation. J Cardiovasc Comput Tomogr 2014; 8:459-67. [PMID: 25467833 DOI: 10.1016/j.jcct.2014.09.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/27/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The nonplanar, saddle-shaped structure of the mitral annulus has been well established through decades of anatomic and echocardiographic study. Its relevance for mitral annular assessment for transcatheter mitral valve implantation is uncertain. OBJECTIVE Our objectives are to define the methodology for CT-based simplified "D-shaped" mitral annular assessment for transcatheter mitral valve implantation and compare these measurements to traditional "saddle-shaped" mitral annular assessment. METHODS The annular contour was manually segmented, and fibrous trigones were identified using electrocardiogram-gated diastolic CT data sets of 28 patients with severe functional mitral regurgitation, yielding annular perimeter, projected area, trigone-to-trigone (TT) distance, and septal-lateral distance. In contrast to the traditional saddle-shaped annulus, the D-shaped annulus was defined as being limited anteriorly by the TT distance, excluding the aortomitral continuity. Hypothetical left ventricular outflow tract (LVOT) clearance was assessed. RESULTS Projected area, perimeter, and septal-lateral distance were found to be significantly smaller for the D-shaped annulus (11.2 ± 2.7 vs 13.0 ± 3.0 cm(2); 124.1 ± 15.1 vs 136.0 ± 15.5 mm; and 32.1 ± 4.0 vs 40.1 ± 4.9 mm, respectively; P < .001). TT distances were identical (32.7 ± 4.1 mm). Hypothetical LVOT clearance was significantly lower for the saddle-shaped annulus than for the D-shaped annulus (10.7 ± 2.2 vs 17.5 ± 3.0 mm; P < .001). CONCLUSION By truncating the anterior horn of the saddle-shaped annular contour at the TT distance, the resulting more planar and smaller D-shaped annulus projects less onto the LVOT, yielding a significantly larger hypothetical LVOT clearance than the saddle-shaped approach. CT-based mitral annular assessment may aid preprocedural sizing, ensuring appropriate patient and device selection.
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Affiliation(s)
- Philipp Blanke
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Danny Dvir
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jian Ye
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Precious
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adam Berger
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Dion Stub
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cameron Hague
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Darra Murphy
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Thompson
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Brad Munt
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert Moss
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert Boone
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David Wood
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gregor Pache
- Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Freiburg, Germany
| | - John Webb
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Computed tomography for planning and postoperative imaging of transvenous mitral annuloplasty: first experience in an animal model. Int J Cardiovasc Imaging 2014; 31:135-42. [DOI: 10.1007/s10554-014-0516-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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87
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Kim K, Kaji S, An Y, Nishino T, Tani T, Kitai T, Furukawa Y. Interpapillary muscle distance independently affects severity of functional mitral regurgitation in patients with systolic left ventricular dysfunction. J Thorac Cardiovasc Surg 2014; 148:434-40.e1. [DOI: 10.1016/j.jtcvs.2013.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/28/2013] [Accepted: 09/10/2013] [Indexed: 12/26/2022]
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Noack T, Kiefer P, Ionasec R, Voigt I, Mansi T, Vollroth M, Hoebartner M, Misfeld M, Mohr FW, Seeburger J. New concepts for mitral valve imaging. Ann Cardiothorac Surg 2013; 2:787-95. [PMID: 24349983 DOI: 10.3978/j.issn.2225-319x.2013.11.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/30/2013] [Indexed: 01/19/2023]
Abstract
The high complexity of the mitral valve (MV) anatomy and function is not yet fully understood. Studying especially the dynamic movement and interaction of MV components to describe MV physiology during the cardiac cycle remains a challenge. Imaging is the key to assessing details of MV disease and to studying the lesion and dysfunction of MV according to Carpentier. With the advances of computational geometrical and biomechanical MV models, improved quantification and characterization of the MV has been realized. Geometrical models can be divided into rigid and dynamic models. Both models are based on reconstruction techniques of echocardiographic or computed tomographic data sets. They allow detailed analysis of MV morphology and dynamics throughout the cardiac cycle. Biomechanical models aim to simulate the biomechanics of MV to allow for examination and analysis of the MV structure with blood flow. Two categories of biomechanical MV models can be distinguished: structural models and fluid-structure interaction (FSI) models. The complex structure and dynamics of MV apparatus throughout the cardiac cycle can be analyzed with different types of computational models. These represent substantial progress in the diagnosis of structural heart disease since MV morphology and dynamics can be studied in unprecedented detail. It is conceivable that MV modeling will contribute significantly to the understanding of the MV.
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Affiliation(s)
- Thilo Noack
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Razvan Ionasec
- Image Analytics and Informatics, Siemens Corporate Research & Technology, 755 College Rd E, Princeton, NJ, USA
| | - Ingmar Voigt
- Image Analytics and Informatics, Siemens Corporate Research & Technology, 755 College Rd E, Princeton, NJ, USA
| | - Tammaso Mansi
- Image Analytics and Informatics, Siemens Corporate Research & Technology, 755 College Rd E, Princeton, NJ, USA
| | - Marcel Vollroth
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Michael Hoebartner
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Joerg Seeburger
- Department of Cardiac Surgery, University Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
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Sizing the mitral annulus in healthy subjects and patients with mitral regurgitation: 2D versus 3D measurements from cardiac CT. Int J Cardiovasc Imaging 2013; 30:389-98. [DOI: 10.1007/s10554-013-0341-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
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90
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Rajiah P, Schoenhagen P. The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention. Insights Imaging 2013; 4:671-89. [PMID: 23907804 PMCID: PMC3781248 DOI: 10.1007/s13244-013-0270-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/07/2013] [Accepted: 06/24/2013] [Indexed: 11/27/2022] Open
Abstract
Advances in our knowledge of cardiovascular disorders coupled with technological innovations have enabled the increased use of minimally invasive cardiovascular surgeries and transcatheter interventions, with resultant reduced morbidity and hospital stay. Three-dimensional imaging, particularly computed tomography (CT) is increasingly used for patient selection, providing a roadmap of the anatomy and identifying factors that may complicate these procedures. Advantages of CT are the rapid turnaround time, good spatial and temporal resolutions, wide field of view and three-dimensional multi-planar reconstruction capabilities. This pictorial review describes the role of CT in the pre-operative evaluation of patients undergoing cardiovascular surgeries and intervention. Main Messages • CT scan is valuable in pre-operative evaluation for cardiac surgeries • Cardiovascular structures, including bypass grafts should be located >10 mm from the sternum in patients for reoperative cardiothoracic surgeries • Knowledge of variations in pulmonary venous anatomy are essential for planning radiofrequency ablation.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA,
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91
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Moodley S, Schoenhagen P, Gillinov AM, Mihaljevic T, Flamm SD, Griffin BP, Desai MY. Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: Impact on decision making. J Thorac Cardiovasc Surg 2013; 146:262-8.e1. [DOI: 10.1016/j.jtcvs.2012.06.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/31/2012] [Accepted: 06/18/2012] [Indexed: 11/26/2022]
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Nasis A, Mottram PM, Cameron JD, Seneviratne SK. Current and Evolving Clinical Applications of Multidetector Cardiac CT in Assessment of Structural Heart Disease. Radiology 2013; 267:11-25. [DOI: 10.1148/radiol.13111196] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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93
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Obase K, Komeda M, Saito K, Tamada T, Fukuhara K, Koyama T, Kume T, Hayashida A, Okura H, Yoshida K. Visualization of Submitral Structure by Three-Dimensional Transesophageal Echocardiography. Echocardiography 2013; 30:945-51. [DOI: 10.1111/echo.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | | | - Ken Saito
- Kawasaki Medical School; Kurashiki; Japan
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94
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Bateman MG, Quill JL, Hill AJ, Iaizzo PA. The clinical anatomy and pathology of the human atrioventricular valves: implications for repair or replacement. J Cardiovasc Transl Res 2013; 6:155-65. [PMID: 23338038 DOI: 10.1007/s12265-012-9437-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/05/2012] [Indexed: 11/25/2022]
Abstract
A critical understanding of cardiac anatomy is essential for design engineers and clinicians with the intent of developing and/or employing improved or novel technologies or therapies for treating an impaired atrioventricular valve. Likewise, such knowledge is required for directing translational research, including initiating preclinical research, assessing the feasibility of clinical trials, and performing first-in-man procedures. There are two atrioventricular valves in the human heart, namely the tricuspid and mitral valves. Both are complex structures whose normal anatomies can vary greatly amongst individuals, and also become modified by disease processes. In this review, we discuss the anatomy, pathology, and issues related to surgical and transcatheter repair of the atrioventricular valves in a translational manner. This article is part of a JCTR special issue on Cardiac Anatomy.
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95
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Gómez de Diego JJ, de Agustín JA. Clinically guided use of Cardiac CT in Valvular heart diseases. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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96
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Buttan AK, Yang EH, Budoff MJ, Vorobiof G. Evaluation of valvular disease by cardiac computed tomography assessment. J Cardiovasc Comput Tomogr 2012; 6:381-92. [DOI: 10.1016/j.jcct.2012.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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97
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Assessment of the morphological features of degenerative mitral valve disease using 64-slice multi detector computed tomography. J Cardiovasc Comput Tomogr 2012; 6:415-21. [DOI: 10.1016/j.jcct.2012.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/13/2012] [Accepted: 10/16/2012] [Indexed: 11/22/2022]
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98
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Achenbach S, Chandrashekhar Y, Narula J. Will procedural complexity cultivate interdisciplinary camaraderie? JACC Cardiovasc Imaging 2012; 5:965-7. [PMID: 22974811 DOI: 10.1016/j.jcmg.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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99
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100
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Mechanism of asymmetric leaflet tethering in ischemic mitral regurgitation: 3D analysis with multislice CT. JACC Cardiovasc Imaging 2012; 5:230-2. [PMID: 22340833 DOI: 10.1016/j.jcmg.2011.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/08/2011] [Accepted: 08/17/2011] [Indexed: 11/21/2022]
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