Keshav Kohli1, Zhenglun Alan Wei1, Ajit P Yoganathan1, John N Oshinski1, Jonathon Leipsic2, Philipp Blanke3,4. 1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA. 2. St. Paul's Hospital & University of British Columbia, Vancouver, Canada. 3. St. Paul's Hospital & University of British Columbia, Vancouver, Canada. phil.blanke@gmail.com. 4. Department of Radiology, St. Paul's Hospital/ Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, USA. phil.blanke@gmail.com.
Abstract
PURPOSE OF REVIEW: Transcatheter mitral valve replacement (TMVR) is an emerging alternative for patients with severe mitral valve regurgitation who are considered at high risk for conventional surgical options. The early clinical experience with TMVR has shown that pre-procedural planning with computed tomography (CT) is needed to mitigate the risk of potentially lethal procedural complications such as left ventricular outflow tract (LVOT) obstruction. The goal of this review is to provide an overview of key concepts relating to TMVR pre-procedural planning, with particular emphasis on imaging-based methods for predicting TMVR-related LVOT obstruction. RECENT FINDINGS: Risk of LVOT obstruction can be assessed with CT-based pre-procedural planning by using virtual device simulations to estimate the residual 'neo-LVOT' cross-sectional area which remains after device implantation. A neo-LVOT area of less than 2 cm2 is currently thought to increase the risk of obstruction; however, additional studies are needed to further validate this cutoff value. Three-dimensional printing and personalized computational simulations are also emerging as valuable tools which may offer insights not readily confered by conventional two-dimensional image analysis. The simulated neo-LVOT should be routinely assessed on pre-procedural CT when evaluating anatomical suitability for TMVR.
PURPOSE OF REVIEW: Transcatheter mitral valve replacement (TMVR) is an emerging alternative for patients with severe mitral valve regurgitation who are considered at high risk for conventional surgical options. The early clinical experience with TMVR has shown that pre-procedural planning with computed tomography (CT) is needed to mitigate the risk of potentially lethal procedural complications such as left ventricular outflow tract (LVOT) obstruction. The goal of this review is to provide an overview of key concepts relating to TMVR pre-procedural planning, with particular emphasis on imaging-based methods for predicting TMVR-related LVOT obstruction. RECENT FINDINGS: Risk of LVOT obstruction can be assessed with CT-based pre-procedural planning by using virtual device simulations to estimate the residual 'neo-LVOT' cross-sectional area which remains after device implantation. A neo-LVOT area of less than 2 cm2 is currently thought to increase the risk of obstruction; however, additional studies are needed to further validate this cutoff value. Three-dimensional printing and personalized computational simulations are also emerging as valuable tools which may offer insights not readily confered by conventional two-dimensional image analysis. The simulated neo-LVOT should be routinely assessed on pre-procedural CT when evaluating anatomical suitability for TMVR.
Authors: Jian Ye; Anson Cheung; Michael Yamashita; David Wood; Defen Peng; Min Gao; Christopher R Thompson; Brad Munt; Robert R Moss; Philipp Blanke; Jonathon Leipsic; Danny Dvir; John G Webb Journal: JACC Cardiovasc Interv Date: 2015-10-14 Impact factor: 11.195
Authors: Dee Dee Wang; Marvin H Eng; Adam B Greenbaum; Eric Myers; Michael Forbes; Patrick Karabon; Milan Pantelic; Thomas Song; Jeff Nadig; Mayra Guerrero; William W O'Neill Journal: Catheter Cardiovasc Interv Date: 2017-12-11 Impact factor: 2.692
Authors: Philipp Blanke; Jong K Park; Paul Grayburn; Christopher Naoum; Kevin Ong; Keshav Kohli; Bjarne L Norgaard; John G Webb; Jeffrey Popma; David Boshell; Paul Sorajja; David Muller; Jonathon Leipsic Journal: J Cardiovasc Comput Tomogr Date: 2017-04-07
Authors: Jaffar M Khan; Vasilis C Babaliaros; Adam B Greenbaum; Jason R Foerst; Shahram Yazdani; James M McCabe; Gaetano Paone; Marvin H Eng; Bradley G Leshnower; Patrick T Gleason; Marcus Y Chen; Dee Dee Wang; Xin Tian; Annette M Stine; Toby Rogers; Robert J Lederman Journal: J Am Coll Cardiol Date: 2019-05-28 Impact factor: 24.094
Authors: Christian Herz; Alana Cianciulli; Stephen Ching; Chad Vigil; Andras Lasso; Hannah H Nam; Simon Drouin; David M Biko; Matthew Gillespie; Gabor Fichtinger; Matthew A Jolley Journal: J Am Soc Echocardiogr Date: 2021-04-02 Impact factor: 7.722
Authors: José Cornejo; Jorge A Cornejo-Aguilar; Mariela Vargas; Carlos G Helguero; Rafhael Milanezi de Andrade; Sebastian Torres-Montoya; Javier Asensio-Salazar; Alvaro Rivero Calle; Jaime Martínez Santos; Aaron Damon; Alfredo Quiñones-Hinojosa; Miguel D Quintero-Consuegra; Juan Pablo Umaña; Sebastian Gallo-Bernal; Manolo Briceño; Paolo Tripodi; Raul Sebastian; Paul Perales-Villarroel; Gabriel De la Cruz-Ku; Travis Mckenzie; Victor Sebastian Arruarana; Jiakai Ji; Laura Zuluaga; Daniela A Haehn; Albit Paoli; Jordan C Villa; Roxana Martinez; Cristians Gonzalez; Rafael J Grossmann; Gabriel Escalona; Ilaria Cinelli; Thais Russomano Journal: Biomed Res Int Date: 2022-03-24 Impact factor: 3.411
Authors: Keshav Kohli; Zhenglun Alan Wei; Vahid Sadri; Andrew W Siefert; Philipp Blanke; Emily Perdoncin; Adam B Greenbaum; Jaffar M Khan; Robert J Lederman; Vasilis C Babaliaros; Ajit P Yoganathan; John N Oshinski Journal: Front Cardiovasc Med Date: 2022-06-09