Computed Tomography Imaging for Mitral Valve Regurgitation

The clinical utility of coronary computed tomography angiography for the evaluation of coronary artery disease is well established in routine cardiology practice. Advances in multidetector computed tomography (MDCT) technology over the past decade have seen dramatic improvements in both spatial and temporal resolution, which has permitted acquisition of high-quality images despite the challenges presented by cardiac motion. Above and beyond allowing for the comprehensive assessment of the epicardial coronary vessels, cardiac chamber contrast opacification with new-generation MDCT scanners also enables accurate and detailed segmentation of the left-sided cardiac valves. Traditional two-dimensional (2D) echocardiography has long been the reference standard for the diagnosis and evaluation of valvular pathology; however, transthoracic echocardiography (TTE) is operator dependent and can be limited in patients with poor acoustic windows, and transesophageal echocardiography (TEE) is invasive. Both approaches limit acquisition to a restricted number of planes/projections, which cannot be subsequently manipulated. In contrast, three-dimensional (3D) imaging techniques such as MDCT permit rapid acquisition of volumetric datasets with unlimited 2D planar reconstruction post-processing capability. This recent development in MDCT technology has fortunately paralleled the rapid expansion of percutaneous valvular repair strategies for patients with symptomatic severe valvular heart disease who are deemed inoperable.