Optimizing Cardiac CT Protocols for Comprehensive Acquisition Prior to Percutaneous MV and TV Repair/Replacement

• Published in: JACC. Cardiovascular imaging Vol. 13; no. 3; pp. 836 - 850
• Main Authors: Pulerwitz, Todd C., Khalique, Omar K., Leb, Jay, Hahn, Rebecca T., Nazif, Tamim M., Leon, Martin B., George, Isaac, Vahl, Torsten P., D’Souza, Belinda, Bapat, Vinayak N., Dumeer, Shifali, Kodali, Susheel K., Einstein, Andrew J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: computed tomography angiography; transcatheter mitral valve repair/replacement; transcatheter tricuspid valve repair/replacement; TV; ECG; computed tomography angiography; MV; transcatheter mitral valve repair/replacement; LVOT; HU; IV; ROI; TAVR; CT; CTA; TMVR; TTVR; transcatheter tricuspid valve repair/replacement
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2019.01.041

Clinical trials of transcatheter mitral valve and tricuspid valve repair and replacement devices have begun in earnest, with the ultimate goal of providing definitive, nonsurgical treatment for the millions of patients with severe, symptomatic regurgitation, many of whom are too high risk or inoperable for a surgical approach. Computed tomography (CT) angiography offers the potential for detailed anatomic assessment in this patient population, but its optimal implementation for patients with mitral and tricuspid disease requires patient-centered protocol specification reflecting the goal of the scan, an understanding of complex anatomy and pathophysiology, and particulars of CT scanner capabilities. In this paper, the need for new interventional approaches to mitral and tricuspid valve disease is discussed, followed by a detailed review of how to perform a high-quality CT angiography examination, taking into consideration scanner- and patient-specific variables when preparing a pre-mitral or tricuspid protocol. The many possible clinical challenges affecting the performance of cardiac and vascular CT angiography for pre-procedure mitral and tricuspid repair/replacement are reviewed and specific tips, trouble-shooting approaches, and recommendations are provided for how to conduct the best-quality study, be it at an experienced imaging center with the most advanced scanner or at a novice center using an earlier generation CT platform. [Display omitted] •Clinical trials have begun of numerous transcatheter mitral valve and tricuspid valve repair and replacement devices.•Cardiac and vascular assessment before transcatheter intervention requires high-quality, anatomy-specific CT angiography protocols.•The many possible clinical challenges affecting CT angiography are reviewed and specific tips and trouble-shooting approaches provided.•As this field rapidly advances, so too will the requirement for high-quality CT angiography protocols.