Assessment of Functional Mitral Regurgitation by Cardiovascular Magnetic Resonance

Abstract

In functional mitral regurgitation the leaflets of the mitral valve appear morphologically normal but do not close adequately due to left ventricular disease, either ischaemic or cardiomyopathic. While echocardiography generally remains the first line modality for investigation of mitral regurgitation, cardiovascular magnetic resonance (CMR) has complementary and additional roles. It enables assessment of the regurgitant fraction, mitral annular dimensions, left and right ventricular volumes and function, the effects of MR on the left atrium and pulmonary arteries, any pathology in other heart valves and the extent and distribution of any scarring and hence the viability of the left ventricle. CMR also contributes to assessment of the reparability of the mitral valve. This chapter covers the CMR acquisition methods used, some relevant approaches to image analysis and, finally, the limitations and strengths of CMR relative to echocardiography.