Author + information
- Received May 30, 2018
- Revision received January 14, 2019
- Accepted January 22, 2019
- Published online August 14, 2019.
- Todd C. Pulerwitz, MDa,b,∗,
- Omar K. Khalique, MDa,b,∗,
- Jay Leb, MDb,
- Rebecca T. Hahn, MDa,
- Tamim M. Nazif, MDa,
- Martin B. Leon, MDa,
- Isaac George, MDc,
- Torsten P. Vahl, MDa,
- Belinda D’Souza, MDb,
- Vinayak N. Bapat, MDc,
- Shifali Dumeer, MDb,
- Susheel K. Kodali, MDa and
- Andrew J. Einstein, MD, PhDa,b,∗ ()
- aDivision of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
- bDepartment of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
- cDepartment of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
- ↵∗Address for correspondence:
Dr. Andrew J. Einstein, Columbia University Medical Center, Department of Medicine, Division of Cardiology, 622 West 168th Street, PH 10-203A, New York, New York 10032.
• 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.
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.
- computed tomography angiography
- transcatheter mitral valve repair/replacement
- transcatheter tricuspid valve repair/replacement
↵∗ Drs. Pulerwitz and Khalique have contributed equally to this manuscript.
Dr. Khalique has received consulting fees from Edwards Lifesciences, Cephea Valves, Jenavalve, and Boston Scientific; and is a member of a Core Lab that holds contracts with Edwards Lifesciences, but receives no direct compensation. Dr. Hahn has received Core Lab contracts with Edwards Lifesciences, but receives no direct compensation; and is a speaker for Philips Healthcare, St. Jude’s Medical, and Boston Scientific. Dr. Nazif has received consulting fees from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Leon is a nonpaid member of the Scientific Advisory Board of Edwards Lifesciences. Dr. George has received consulting fees from Edwards Lifesciences, Medtronic, W. L. Gore, MITRx, and Mitre Medical; and is a speaker for Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Vahl has received consulting fees from Edwards Lifesciences and JenaValve Technology. Dr. Bapat has received consulting fees from Edwards Lifesciences, Medtronic, and Abbott. Dr. Kodali has received consulting fees from Edwards Lifesciences, Abbott Vascular, Meril Lifesciences, Claret Medical, Admedus; is on the Advisory Board of Dura Biotech, Thubrikar Aortic Valve, Inc., and Biotrace Medical has received honoraria from Abbott Vascular, Meril Lifesciences, Claret Medical, and Admedus; and has equity in Thubrikar Aortic Valve Inc., Dura Biotech, and Biotrace Medical. Dr. Einstein has received research grants to Columbia University from Canon Medical Systems and Roche Diagnostics; and has served as a consultant to GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 30, 2018.
- Revision received January 14, 2019.
- Accepted January 22, 2019.
- 2019 American College of Cardiology Foundation
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