CONTEMPORARY SCIENTIFIC TRENDS IN MITRAL VALVE EVALUATION FOR TRANSCATHETER MITRAL VALVE REPLACEMENT PLANNING BY COMPUTED TOMOGRAPHY

Authors:

Abstract:

Mitral regurgitation is one of the most common valvular diseases in aging populations, and the structural complexity of the mitral valve together with the heterogeneity of regurgitation mechanisms necessitates precise multimodality imaging. While echocardiography remains the first-line modality, computed tomography has become essential for pre-procedural evaluation in transcatheter mitral valve replacement, offering accurate annular measurements, detailed subvalvular assessment, and prediction of the neo-left ventricular outflow tract. This review summarizes current evidence on the role of CT in anatomical assessment of the mitral valve and transcatheter mitral valve replacement planning, incorporating methodological frameworks developed by leading structural imaging groups, including approaches to saddle-shaped versus D-shaped annular modeling, dynamic annular behavior, and device-specific considerations. CT provides high spatial resolution and reproducibility, and further standardization of CT-based annular modeling and neo-LVOT prediction remains crucial as TMVR technologies continue to evolve.

Keywords:

mitral valve mitral regurgitation computed tomography transcatheter mitral valve replacement annular sizing structural heart imaging

References:

1. Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, et al. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging. 2023;24(9):e209-68. doi:10.1093/ehjci/jead096.
2. Alexis SL, Sengupta A, Zaid S, Kaple R, Ahmad H, Malik A, et al. Transcatheter mitral valve replacement: procedural planning, utility, and applicability. Cardiol Rev. 2021;29(2):96-9. doi:10.1097/CRD.0000000000000344.
3. Alperi A, Granada JF, Bernier M, Dagenais F, Rodés-Cabau J. Current status and future prospects of transcatheter mitral valve replacement: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77(24):3058-78. doi:10.1016/j.jacc.2021.04.051.
4. Aoun J, Reardon MJ, Goel SS. Transcatheter mitral valve replacement: an update. Curr Opin Cardiol. 2021;36(4):384-9. doi:10.1097/HCO.0000000000000860.
5. Barreiro-Perez M, Caneiro-Queija B, Puga L, Gonzalez-Ferreiro R, Alarcon R, Parada JA, et al. Imaging in transcatheter mitral valve replacement: state-of-art review. J Clin Med. 2021;10(24):5973. doi:10.3390/jcm10245973.
6. Belfekih A, Masri A, Veugeois A, Diakov C, Mahmoudi K, Ribeyrolles S, et al. Alcohol septal ablation for left ventricle outflow tract obstruction prevention before transcatheter mitral valve replacement procedure: computed tomography analysis series. Catheter Cardiovasc Interv. 2025;105(5):1241-50. doi:10.1002/ccd.31446.
7. Brown RA, Hensey M, Lal S, Sathananthan J, Ye J, Cheung A, et al. Transcatheter mitral valve replacement: an update on current techniques, technologies, and future directions. JACC Cardiovasc Interv. 2021;14(5):489-500. doi:10.1016/j.jcin.2020.12.038.
8. Chen QF, Shi S, Wang YF, Shi J, Liu C, Xu T, et al. Global, regional, and national burden of valvular heart disease, 1990 to 2021. J Am Heart Assoc. 2024;13(24):e037991. doi:10.1161/JAHA.124.037991.
9. Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021;18(12):853-64. doi:10.1038/s41569-021-00570-z.
10. Debski M, Qadri S, Bhalraam U, Dębska K, Vassiliou VS, Zacharias J. Comparison of mitral valve repair vs. replacement for mitral valve regurgitation. European Heart Journal – Quality of Care and Clinical Outcomes, Volume 11, Issue 5, August 2025, Pages 587–603, https://doi.org/10.1093/ehjqcco/qcae108.
11. Elison D, Khan J. Left ventricular outflow tract and transcatheter mitral valve replacement obstruction and TMVR: predictors, evaluation, and solutions. Struct Heart. 2024;8(4):100299. doi:10.1016/j.shj.2024.100299.
12. Fiorilli PN, Herrmann HC, Szeto WY. Transcatheter mitral valve replacement: latest advances and future directions. Ann Cardiothorac Surg. 2021;10(1):85-95. doi:10.21037/acs-2020-mv-21.
13. Ge Y, Gupta S, Fentanes E, Aghayev A, Steigner M, Sobieszczyk P, et al. Role of cardiac CT in pre-procedure planning for transcatheter mitral valve replacement. JACC Cardiovasc Imaging. 2021;14(8):1571-80. doi:10.1016/j.jcmg.2020.12.018.
14. Gheorghe LL, Mobasseri S, Agricola E, Wang DD, Milla F, Swaans M, et al. Imaging for native mitral valve surgical and transcatheter interventions. JACC Cardiovasc Imaging. 2021;14(1):112-27. doi:10.1016/j.jcmg.2020.11.021.
15. Gössl M, Thourani V, Babaliaros V, Conradi L, Chehab B, Dumonteil N, et al. Early outcomes of transcatheter mitral valve replacement with the Tendyne system in severe mitral annular calcification. EuroIntervention. 2022;17(18):1523-31. doi:10.4244/EIJ-D-21-00952.
16. Hashimoto G, Lopes BBC, Sato H, Fukui M, Garcia S, Gössl M, et al. Computed tomography planning for transcatheter mitral valve replacement. Struct Heart. 2022;6(1):100012. doi:10.1016/j.shj.2022.100012.
17. Heiser L, Gohmann RF, Noack T, Renatus K, Lurz P, Thiele H, et al. CT planning prior to transcatheter mitral valve replacement (TMVR). Rofo. 2022;194(4):373-83. doi:10.1055/a-1718-4182.
18. Hensey M, Brown RA, Lal S, Sathananthan J, Ye J, Cheung A, et al. Transcatheter mitral valve replacement: an update on current techniques, technologies, and future directions. JACC Cardiovasc Interv. 2021;14(5):489-500. doi:10.1016/j.jcin.2020.12.038.
19. Husain A, Meier D, Dundas J, Akodad M, Jelisejevas J, Zaky F, et al. Transcatheter mitral valve replacement: 5 years later. JACC Cardiovasc Interv. 2023;16(23):2920-2. doi:10.1016/j.jcin.2023.09.032.
20. Lopes P, Van Herck PL, Ooms JF, Van Mieghem NM, Wirix-Speetjens R, Sijbers J, et al. Automated mitral valve assessment for transcatheter mitral valve replacement planning. Front Bioeng Biotechnol. 2022;10:1033713. doi:10.3389/fbioe.2022.1033713.
21. Ludwig S, Perrin N, Coisne A, Ben Ali W, Weimann J, Duncan A, et al. Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry. EuroIntervention. 2023;19(6):512-25. doi:10.4244/EIJ-D-22-00652.
22. Lutter G, Bax L, Liu Y, Hansen JH, Frank D, Freitag-Wolf S, et al. Transcatheter mitral valve replacement: tissue in-growth after 4 weeks. Interact Cardiovasc Thorac Surg. 2021;32(1):1-8. doi:10.1093/icvts/ivaa259.
23. Meier D, Akodad M, Tzimas G, Muller O, Cheung A, Wood DA, et al. Update on transcatheter treatment of mitral and tricuspid valve regurgitation. Curr Cardiol Rep. 2023;25(10):1361-71. doi:10.1007/s11886-023-01954-y.
24. Ninios V, Ninios I, Ranard LS, Vahl TP, Wróbel K. Transcatheter transseptal treatment of patients with severe mitral regurgitation using an atrial fixation mitral valve replacement technology. Cardiovasc Revasc Med. 2024;58:25-30. doi:10.1016/j.carrev.2023.10.018.
25. O’Neill B, Halboni A, Giustino G, Engel P, Fram G, Frisoli T, et al. Treatment patterns of patients with mitral valve disease and critical neo-LVOT obstruction. Catheter Cardiovasc Interv. 2025;106(4):2488-94. doi:10.1002/ccd.70091.
26. Orban M, Karam N, Lubos E, Kalbacher D, Braun D, Deseive S, et al. Impact of proportionality of secondary mitral regurgitation on outcome after transcatheter mitral valve repair. JACC Cardiovasc Imaging. 2021;14(4):715-25. doi:10.1016/j.jcmg.2020.08.017.
27. Passey S, Patail H, Spevack D, Ahmad H, Ohira S, Shimamura J, et al. Updated Review of Transcatheter Strategies and Intervention for Mitral Regurgitation. Cardiol Rev. 2025 Feb 27. doi: 10.1097/CRD.0000000000000876.
28. Piroli F, Boccellino A, Ingallina G, Rolando M, Melillo F, Ancona F, et al. Feasibility and reliability of comprehensive three-dimensional transoesophageal echocardiography screening process for transcatheter mitral valve replacement. Eur Heart J Cardiovasc Imaging. 2023;24(8):1043-51. doi:10.1093/ehjci/jead015.
29. Puehler T, Blanke P, Seoudy H, Sathananthan J, Sellers SL, Meier D, et al. Comparison of predicted and confirmed neo-LVOT after transcatheter mitral valve replacement. JACC Cardiovasc Interv. 2022;15(20):e219-21. doi:10.1016/j.jcin.2022.07.021
30. Saxon JT, Genereux P, Ninios V, Waggoner T, Tahirkheli N, Grygier M, et al. Transcatheter mitral valve replacement with atrial fixation for atrial functional mitral regurgitation. Circ Cardiovasc Interv. 2025;18(4):e014985. doi:10.1161/CIRCINTERVENTIONS.124.014985
31. Sorajja P, Thourani VH, Rogers JH, Bethea B, Guerrero ME, Lim DS, et al. Transcatheter Mitral Valve Replacement for Severe Mitral Annular Calcification: Primary Outcomes From the SUMMIT-MAC Study.
32. Tartaglia F, Antonelli G, Gitto M, Stankowski K, Donia D, Stefanini G, et al. TMVR for the treatment of mitral regurgitation: a state-of-the-art review. Circ Cardiovasc Interv. 2025;18(10):e015298. doi:10.1161/CIRCINTERVENTIONS.125.015298.
33. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi:10.1093/eurheartj/ehab395.
34. Vajapey R, Kwon D. Guide to functional mitral regurgitation: a contemporary review. Cardiovasc Diagn Ther. 2021;11(3):781-92. doi:10.21037/cdt-20-302
35. Xu B, Kocyigit D, Wang TKM, Tan CD, Rodriguez ER, Pettersson GB, et al. Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management. Eur Heart J Cardiovasc Imaging. 2022;23(3):e111-22. doi:10.1093/ehjci/jeab215
36. Zillner L, Wild MG, Hell MM, Herkner H, Kuhn EW, Rudolph T, et al. An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement. J Clin Med. 2025 Jun 20;14(13):4412. doi: 10.3390/jcm14134412.

Publication:

«World of Medicine and Biology» Vol. 22 No. 1 (2026) , с. 255-261
УДК 616-079.2.617-089.844

DOI:

https://doi.org/10.26724/2079-8334-2026-1-95-255-261