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Van Mieghem NM. Transcatheter Mitral Valve Replacement: The Road to Redemption. JACC Cardiovasc Interv 2024; 17:1452-1454. [PMID: 38639688 DOI: 10.1016/j.jcin.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
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2
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Faza NN, Harb SC, Wang DD, van den Dorpel MMP, Van Mieghem N, Little SH. Physical and Computational Modeling for Transcatheter Structural Heart Interventions. JACC Cardiovasc Imaging 2024; 17:428-440. [PMID: 38569793 DOI: 10.1016/j.jcmg.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/05/2024]
Abstract
Structural heart disease interventions rely heavily on preprocedural planning and simulation to improve procedural outcomes and predict and prevent potential procedural complications. Modeling technologies, namely 3-dimensional (3D) printing and computational modeling, are nowadays increasingly used to predict the interaction between cardiac anatomy and implantable devices. Such models play a role in patient education, operator training, procedural simulation, and appropriate device selection. However, current modeling is often limited by the replication of a single static configuration within a dynamic cardiac cycle. Recognizing that health systems may face technical and economic limitations to the creation of "in-house" 3D-printed models, structural heart teams are pivoting to the use of computational software for modeling purposes.
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Affiliation(s)
- Nadeen N Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | | | | | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Tsujimoto T, Tedoriya T, Yamauchi Y, Okita Y, Okada K. Virtual Reality Computed Tomography Evaluation - Anatomy and Clinical Implications for Valve-Sparing Aortic Root Replacement. Circ J 2024; 88:589-596. [PMID: 36216551 DOI: 10.1253/circj.cj-22-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Three-dimensional aortic root evaluation using virtual reality (VR) techniques for valve-sparing aortic root replacement (VSARR) preparation has not yet been implemented, so we demonstrated VR computed tomography (VR-CT) and assessed its utility for VSARR.Methods and Results: We enrolled 72 patients who underwent multidetector CT before elective VSARR for annuloaortic ectasia with tricuspid aortic valve. The geometries of their aortic roots were measured with a VR-CT workstation. The mean values of geometric height (GH), free margin length (FML), and commissural height (CH) were 17.2±2.4 mm, 36.0±5.2 mm, and 24.0±4.3 mm, respectively. The right coronary/noncoronary CH was significantly greater than the left coronary/right coronary and left coronary/noncoronary CH. The left coronary cusp had the shortest FML, intercommissural distances (ICD), and smallest central angle. Although the right coronary cusp had the largest values for FML, ICD, and central angle, the right coronary cusp had the lowest GH and EH. The VR-CT measurements strongly correlated with intraoperative alternatives, especially with mean GH (R2=0.75) and left coronary/noncoronary CH (R2=0.79). Furthermore, mean GH was observed to be significantly different among the selected graft size groups; therefore, the preoperative mean GH could play a significant role in graft sizing. CONCLUSIONS VR-CT evaluation allows a thorough understanding of aortic root anatomy, which could facilitate VSAAR.
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Affiliation(s)
- Takanori Tsujimoto
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Takeo Tedoriya
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
- Department of Cardiovascular Surgery, Ageo Central General Hospital
| | | | - Yutaka Okita
- Department of Cardiovascular Surgery, Aijinkai Takatsuki General Hospital
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
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Hell MM, Emrich T, Lurz P, von Bardeleben RS, Schmermund A. Cardiac CT Beyond Coronaries: Focus on Structural Heart Disease. Curr Heart Fail Rep 2023; 20:484-492. [PMID: 38019324 PMCID: PMC10746749 DOI: 10.1007/s11897-023-00635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW Cardiac computed tomography (CT) is an established non-invasive imaging tool for the assessment of coronary artery disease. Furthermore, it plays a key role in the preinterventional work-up of patients presenting with structural heart disease. RECENT FINDINGS CT is the gold standard for preprocedural annular assessment, device sizing, risk determination of annular injury, coronary occlusion or left ventricular outflow tract obstruction, calcification visualization and quantification of the target structure, and prediction of a co-planar fluoroscopic angulation for transcatheter interventions in patients with structural heart disease. It is further a key imaging modality in postprocedural assessment for prosthesis thrombosis, degeneration, or endocarditis. CT plays an integral part in the imaging work-up of novel transcatheter therapies for structural heart disease and postprocedural assessment for prosthesis thrombosis or endocarditis. This review provides a comprehensive overview of the key role of CT in the context of structural heart interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | | | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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5
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Andrés-Cordón JF, Vilalta V, Millán X, Moustafa AH, Fernández-Nofrerias E, Julià I, Carrillo X, Delgado V. Complex Mitral Paravalvular Leak Closure: 3D Printing to the Rescue. JACC Cardiovasc Interv 2023; 16:2181-2182. [PMID: 37354165 DOI: 10.1016/j.jcin.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Joan F Andrés-Cordón
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Victoria Vilalta
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Xavier Millán
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Ignasi Julià
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xavier Carrillo
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Victoria Delgado
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Reyaldeen R, Kaur S, Krishnaswamy A, Ramchand J, Layoun H, Schoenhagen P, Miyasaka R, Unai S, Kapadia SR, Harb SC. Role of Cardiac Computed Tomography in Planning Transcatheter Mitral Valve Replacement (TMVR). Curr Cardiol Rep 2022; 24:1917-1932. [PMID: 36334213 DOI: 10.1007/s11886-022-01794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Transcatheter mitral valve replacement (TMVR) is an evolving and rapidly expanding field within structural interventions, offering renewed treatment options for patients with high-risk mitral valve disease. We aim to highlight and illustrate the importance of cardiac CT in the planning of TMVR. RECENT FINDINGS As TMVR has evolved, so has the specific nuances of cardiac CT planning, we now understand the importance of accurate annular sizing and valve simulation to predict complications such as neo-LVOT obstruction and paravalvular leak (PVL). More so than any other modality, cardiac CT remains instrumental in accurately planning TVMR from feasibility, device sizing, access, and fluoroscopic angles. Cardiac CT remains the key modality in TMVR evaluation, often the first step in determining patient eligibility through comprehensive procedural planning as well as informing potential outcomes and prognosis. In this review, we discuss the critical role of cardiac computed tomography (CT) and the specific considerations involved in TMVR.
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Affiliation(s)
- Reza Reyaldeen
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jay Ramchand
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Cocchieri R, van de Wetering B, van Tuijl S, Mousavi I, Riezebos R, de Mol B. At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology. J Cardiovasc Dev Dis 2022; 9:jcdd9080261. [PMID: 36005425 PMCID: PMC9410306 DOI: 10.3390/jcdd9080261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Almost 30 years after the first endoscopic mitral valve repair, Minimally Invasive Mitral Valve Surgery (MIMVS) has become the standard at many institutions due to optimal clinical results and fast recovery. The question that arises is can already good results be further improved by an Institutional Risk Management Performance (IRMP) system in decreasing risks in minimally invasive mitral valve surgery (MIMVS)? As of yet, there are no reports on IRMP and learning systems in the literature. (2) Methods: We described and appraised our five-year single institutional experience with MIMVS in isolated valve surgery included in the Netherlands Heart Registry (NHR) and investigated root causes of high-impact complications. (3) Results: The 120-day and 12-month mortality were 1.1% and 1.9%, respectively, compared to the average of 4.3% and 5.3% reported in the NHR. The regurgitation rate was 1.4% compared to 5.2% nationwide. The few high-impact complications appeared not to be preventable. (4) Discussion: In MIMVS, freedom from major and minor complications is a strong indicator of an effective IRMP but remains concealed from physicians and patients, despite its relevance to shared decision making. Innovation adds to the complexity of MIMVS and challenges surgical competence. An IRMP system may detect and control new risks earlier. (5) Conclusion: An IRMP system contributes to an effective reduction of risks, pain and discomfort; provides relevant input for shared decision making; and warrants the safe introduction of new technology. Crossroads conclusions: investment in machine learning and AI for an effective IRMP system is recommended and the roles for commanding and operating surgeons should be considered.
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Affiliation(s)
- Riccardo Cocchieri
- Cardiothoracic Surgeon, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Bertus van de Wetering
- Biomedical Engineer, LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Sjoerd van Tuijl
- Biomedical Engineer, LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Iman Mousavi
- Cardiothoracic Surgery Resident, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Robert Riezebos
- Cardiologist, OLVG Hospital, 1091 AC Amsterdam, The Netherlands
| | - Bastian de Mol
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
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Gaidulis G, Suresh KS, Xu D, Padala M. Patient-Specific Three-Dimensional Ultrasound Derived Computational Modeling of the Mitral Valve. Ann Biomed Eng 2022; 50:847-859. [PMID: 35380321 PMCID: PMC10826907 DOI: 10.1007/s10439-022-02960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/27/2022] [Indexed: 11/01/2022]
Abstract
Several new techniques to repair the mitral valve affected by functional mitral regurgitation are in development. However, due to the heterogeneity of valve lesions between patients, predicting the outcomes of novel treatment approaches is challenging. We present a patient-specific, 3D ultrasound-derived computational model of the mitral valve for procedure planning, that faithfully mimics the pathological valve dynamics. 3D ultrasound images were obtained in three pigs induced with heart failure and which developed functional mitral regurgitation. For each case, images were segmented, and finite element model of mitral valve was constructed. Annular and papillary muscle dynamics were extracted and imposed as kinematic boundary conditions, and the chordae were pre-strained to induce valve tethering. Valve closure was simulated by applying physiologic transvalvular pressure on the leaflets. Agreement between simulation results and truth datasets was confirmed, with accurate location of regurgitation jets and coaptation defects. Inclusion of kinematic patient-specific boundary conditions was necessary to achieve these results, whereas use of idealized boundary conditions deviated from the truth dataset. Due to the impact of boundary conditions on the model, the effect of repair strategies on valve closure varied as well, indicating that our approach of using patient-specific boundary conditions for mitral valve modeling is valid.
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Affiliation(s)
- Gediminas Gaidulis
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, 380B Northyards Blvd NW, Atlanta, GA, 30313, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirthana Sreerangathama Suresh
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, 380B Northyards Blvd NW, Atlanta, GA, 30313, USA
| | - Dongyang Xu
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, 380B Northyards Blvd NW, Atlanta, GA, 30313, USA
| | - Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, 380B Northyards Blvd NW, Atlanta, GA, 30313, USA.
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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McCabe JM, Hamid N, Elison DM. Many Valves Make Heavy Work. JACC Case Rep 2022; 4:516-518. [PMID: 35573848 PMCID: PMC9091512 DOI: 10.1016/j.jaccas.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- James M. McCabe
- Heart Institute, University of Washington, Seattle, Washington, USA
| | - Nadira Hamid
- Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - David M. Elison
- Heart Institute, University of Washington, Seattle, Washington, USA
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10
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Khokhar AA, Zlahoda-Huzior A, Stanuch M, Ponticelli F, Ruggiero R, Chandra K, Kim WK, Giannini F, Dudek D. Advanced CT-based imaging techniques to evaluate coronary access following TAVI for degenerated surgical bioprosthesis. Can J Cardiol 2021; 38:392-394. [PMID: 34798083 DOI: 10.1016/j.cjca.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/15/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Coronary access following transcatheter aortic valve implantation (TAVI) can be challenging. We describe the use of CT-based advanced imaging techniques to evaluate, plan and simulate coronary access following TAVI for a degenerated surgical bioprosthesis. Post-procedural CT data was segmented to create a 3D digital model, which was visualised using mixed reality technology to enable operators to virtually plan a cannulation strategy. Bench-testing was then performed in a patient-specific 3D printed model to determine the optimal coronary cannulation technique. Our case demonstrates how CT-based advanced imaging techniques can be used to improve pre-procedural planning of structural heart interventions.
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Affiliation(s)
- Arif A Khokhar
- Imperial College Healthcare NHS Trust, London, UK; Digital Innovations & Robotics Hub, Krakow, Poland.
| | - Adriana Zlahoda-Huzior
- AGH University of Science and Technology, Department of Measurement and Electronics, Krakow, Poland
| | - Maciej Stanuch
- AGH University of Science and Technology, Department of Measurement and Electronics, Krakow, Poland
| | | | - Rossella Ruggiero
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Kailash Chandra
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Giannini
- Interventional cardiology unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Dariusz Dudek
- Imperial College Healthcare NHS Trust, London, UK; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Sadeghi AH, Ooms JF, Bakhuis W, Taverne YJHJ, Van Mieghem NM, Bogers AJJC. Immersive Virtual Reality Heart Models for Planning of Transcatheter Paravalvular Leak Closure: A Feasibility Study. JACC Cardiovasc Interv 2021; 14:1854-1856. [PMID: 34412809 DOI: 10.1016/j.jcin.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
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Abstract
Purpose of Review We aimed to picture the contemporary landscape of available catheter-based repair and replacement solutions for mitral regurgitation (MR) in Europe. Recent Findings Edge-to-edge repair remains the dominant technique for transcatheter mitral valve repair especially in the context of secondary mitral regurgitation. Two recent randomized trials reported seemingly contradicting clinical results with transcatheter edge-to-edge repair for patients with heart failure and severe secondary MR. A proportionality framework related to secondary MR was proposed to help explain inconsistencies but requires further research. (In)Direct annuloplasty primarily aims to correct secondary MR; however, the scientific basis seems less robust. One dedicated transcatheter heart valve has the CE mark for mitral valve replacement but requires transapical access. Balloon-expandable transcatheter aortic valve platforms are emerging for transvenous transseptal mitral replacement in the context of mitral annular calcification, a failing surgical mitral bioprosthesis, or annuloplasty. Advanced computed tomography imaging techniques improved pre-procedural planning and introduced the option for modeling and simulation. Summary Development of a toolbox of catheter-based technologies, complementary imaging modalities, and refined patient selection offer novel perspectives to high-risk patients with primary or secondary MR. Clinical trials are required to help formulate evidence-based guidelines for the management of mitral valve disease.
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Computational Simulation, Bench Testing, and Modeling: Novel Tools to Strategize and Optimize Interventional Procedures. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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