Imaging of the Mitral Valve Role of CT and MRI Pr. Alban REDHEUIL Département d’Imagerie Cardiovasculaire Institut de Cardiologie, La Pitié Salpêtrière, Paris Laboratoire d’Imagerie Biomédicale INSERM-CNRS ICAN Imaging Core Lab SFICV Imagerie des valves Deauville, juin 2017
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Imaging of the Mitral Valve - JFICV · Imaging of the Mitral Valve Role of CT and MRI Pr. Alban REDHEUIL ... CT RF vs. Echo grade CT vs. Echo : mitral valve motion. Mitral Valve Regurgitation
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Imaging of the Mitral ValveRole of CT and MRI
Pr. Alban REDHEUIL
Département d’Imagerie Cardiovasculaire
Institut de Cardiologie, La Pitié Salpêtrière, Paris
Laboratoire d’Imagerie Biomédicale INSERM-CNRS
ICAN Imaging Core Lab
SFICVImagerie des valvesDeauville, juin 2017
Valvular Heart DiseasePrevalence and Outcome
Nkomo VT et al. Burden of valvular heart diseases: a population-based study. Lancet 2006
PREVALENCE SURVIVAL
Iung et al. EHJ 2003
Carabello BA et Paulus WJ. Aortic stenosis. Lancet 2009;373: 956-66
Valvular heart diseaseClinical presentation and role of imaging: example of AS
Valvular Heart DiseaseRole of imaging
• Primary diagnosis: lesion, etiology, severity
• Associated valvular disease
• Differential diagnosis: MR vs. DCM
• Cardiac remodeling: LV, LA, RV and PA
• Coronary arteries (preoperative workup)
• Timing of valvular intervention
• Post operative assessment/follow-up
Transthoracic echocardiography
• First line modality for initial assessment and longitudinal evaluation
• cost-effective, widely available
• great temporal resolution (≈2 ms)
• absence of partial volume effects
• Pulmonary pressures (SPAP)
• Exercise
• Limitations– Incomplete acoustic windows
(pulmonary valve)
– operator dependent
Transesophageal echocardiography
& 3D
• if TTE is of suboptimal
quality
• if thrombosis, prosthetic
dysfunction or
endocarditis is suspected
• optimal investigation for
mitral leaflet assessment
• superior leaflet detail
• 3D images
Guidelines ESC
IRM• Exploration échographique
insuffisante ou résultats conflictuels
• Quantifications des insuffisances/sténoses valvulaires
– Insuffisance>sténose
– Valve pulmonaire
• Examen de référence
– Volumes, fonction bi ventriculaire
– Fibrose myocardique
Scanner
Vahanian et al. EHJ 2012
8%8%
Intérêt de l’IRM
FORCES•Imagerie CV exhaustive et non invasive (ETO)
•Multiparamétrique: anatomie (angio 3D), cinétique (ciné), flux (contraste de phase)