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CMR in Transcatheter Valve Interventions: State of the Art and Future Directions

  • Cardiac Magnetic Resonance (E Nagel and V Püntmann, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Transcatheter valve interventions require careful planning and rely heavily on multimodality imaging. In contrast to echocardiography and computed tomography cardiovascular magnetic resonance (CMR) remains underused in clinical practice.

Recent Findings

CMR techniques such as multiplanar cine imaging unlimited by echo windows or ionizing radiation exposure, quantification of flow, and advanced tissue characterization have the potential to add valuable complimentary information to the evaluation of patients with valvular heart disease.

Summary

In this paper, we review the evidence for CMR to guide transcatheter valve interventions with a focus on practical applications for the interventionist.

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Abbreviations

AR:

Aortic regurgitation

AS:

Aortic stenosis

CMR:

Cardiovascular magnetic resonance

MR:

Mitral regurgitation

MS:

Mitral stenosis

TAVR:

Transcatheter aortic valve replacement

TR:

Tricuspid regurgitation

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.

    Article  CAS  Google Scholar 

  2. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98.

    Article  CAS  Google Scholar 

  3. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.

    Article  CAS  Google Scholar 

  4. Rogers T, Waksman R. Role of CMR in TAVR. JACC Cardiovasc Imaging. 2016;9(5):593–602.

    Article  Google Scholar 

  5. Mathew RC, Loffler AI, Salerno M. Role of cardiac magnetic resonance imaging in valvular heart disease: diagnosis, assessment, and management. Curr Cardiol Rep. 2018;20(11):119.

    Article  Google Scholar 

  6. • Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30(4):303–71 These recommendations summarize the complimentary role of echocardiography and CMR in the evaluation of patients with valvular regurgitation.

  7. Caruthers SD, Lin SJ, Brown P, Watkins MP, Williams TA, Lehr KA, et al. Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation. 2003;108(18):2236–43.

    Article  Google Scholar 

  8. Wang DD, Gheewala N, Shah R, Levin D, Myers E, Rollet M, et al. Three-dimensional printing for planning of structural heart interventions. Interv Cardiol Clin. 2018;7(3):415–23.

    PubMed  Google Scholar 

  9. Bramlet M, Olivieri L, Farooqi K, Ripley B, Coakley M. Impact of three-dimensional printing on the study and treatment of congenital heart disease. Circ Res. 2017;120(6):904–7.

    Article  CAS  Google Scholar 

  10. Harb SC, Rodriguez LL, Svensson LG, Xu B, Elgharably H, Klatte R, et al. Pitfalls and pearls for 3-dimensional printing of the tricuspid valve in the procedural planning of percutaneous transcatheter therapies. JACC Cardiovasc Imaging. 2018;11(10):1531–4.

    Article  Google Scholar 

  11. Wang J, Jagasia DH, Kondapally YR, Herrmann HC, Han Y. Comparison of non-contrast cardiovascular magnetic resonance imaging to computed tomography angiography for aortic annular sizing before Transcatheter aortic valve replacement. J Invasive Cardiol. 2017;29(7):239–45.

    PubMed  Google Scholar 

  12. Mayr A, Klug G, Reinstadler SJ, Feistritzer HJ, Reindl M, Kremser C, et al. Is MRI equivalent to CT in the guidance of TAVR? A pilot study. Eur Radiol. 2018. https://doi.org/10.1007/s00330-018-5386-2. [Epub ahead of print].

  13. Ribeiro HB, Orwat S, Hayek SS, Larose E, Babaliaros V, Dahou A, et al. Cardiovascular magnetic resonance to evaluate aortic regurgitation after transcatheter aortic valve replacement. J Am Coll Cardiol. 2016;68(6):577–85.

    Article  Google Scholar 

  14. Kammerlander AA, Wiesinger M, Duca F, Aschauer S, Binder C, Zotter Tufaro C, et al. Diagnostic and prognostic utility of cardiac magnetic resonance imaging in aortic regurgitation. JACC Cardiovasc Imaging. 2018. https://doi.org/10.1016/j.jcmg.2018.08.036. [Epub ahead of print].

  15. Rodriguez-Palomares JF, Dux-Santoy L, Guala A, Kale R, Maldonado G, Teixido-Tura G, et al. Aortic flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease. J Cardiovasc Magn Reson. 2018;20(1):28.

    Article  Google Scholar 

  16. • Musa TA, Treibel TA, Vassiliou VS, Captur G, Singh A, Chin C, et al. Myocardial scar and mortality in severe aortic stenosis. Circulation, This study demonstrated that late gadolinium enhancement was independently associated with mortality in patients with severe aortic stenosis. 2018;138(18):1935–47.

  17. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. 2018;71(8):860–71.

    Article  Google Scholar 

  18. Treibel TA, Fontana M, Gilbertson JA, Castelletti S, White SK, Scully PR, et al. Occult transthyretin cardiac amyloid in severe calcific aortic stenosis: prevalence and prognosis in patients undergoing surgical aortic valve replacement. Circ Cardiovasc Imaging. 2016;9(8).

  19. Castano A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A, et al. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J. 2017;38(38):2879–87.

    Article  Google Scholar 

  20. Scully PR, Treibel TA, Fontana M, Lloyd G, Mullen M, Pugliese F, et al. Prevalence of cardiac amyloidosis in patients referred for transcatheter aortic valve replacement. J Am Coll Cardiol. 2018;71(4):463–4.

    Article  Google Scholar 

  21. Uretsky S, Argulian E, Narula J, Wolff SD. Use of cardiac magnetic resonance imaging in assessing mitral regurgitation: current evidence. J Am Coll Cardiol. 2018;71(5):547–63.

    Article  Google Scholar 

  22. Sommer G, Bremerich J, Lund G. Magnetic resonance imaging in valvular heart disease: clinical application and current role for patient management. J Magn Reson Imaging. 2012;35(6):1241–52.

    Article  Google Scholar 

  23. Myerson S. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:7.

    Article  Google Scholar 

  24. Penicka M, Vecera J, Mirica DC, Kotrc M, Kockova R, Van Camp G. Prognostic implications of magnetic resonance-derived quantification in asymptomatic patients with organic mitral regurgitation: comparison with Doppler echocardiography-derived integrative approach. Circulation. 2018;137(13):1349–60.

    Article  Google Scholar 

  25. •• Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, Landmark paper demonstrating for the first time a mortality benefit from transcatheter mitral valve repair. 2018.

  26. Patel A, Bapat V. Transcatheter mitral valve replacement: device landscape and early results. EuroIntervention. 2017;13(AA):AA31–A9.

    Article  Google Scholar 

  27. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018. https://doi.org/10.1016/j.jacc.2018.08.1028. [Epub ahead of print].

  28. Schievano S, Coats L, Migliavacca F, Norman W, Frigiola A, Deanfield J, et al. Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson. 2007;9(4):687–95.

    Article  Google Scholar 

  29. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol. 2004;43(6):1068–74.

    Article  Google Scholar 

  30. Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson. 2011;13:9.

    Article  Google Scholar 

  31. Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet. 2000;356(9239):1403–5.

    Article  CAS  Google Scholar 

  32. Bergersen L, Benson LN, Gillespie MJ, Cheatham SL, Crean AM, Hor KN, et al. Harmony feasibility trial: acute and short-term outcomes with a self-expanding transcatheter pulmonary valve. JACC Cardiovasc Interv. 2017;10(17):1763–73.

    Article  Google Scholar 

  33. Martin MH, Meadows J, McElhinney DB, Goldstein BH, Bergersen L, Qureshi AM, et al. Safety and feasibility of melody transcatheter pulmonary valve replacement in the native right ventricular outflow tract: A Multicenter Pediatric Heart Network Scholar Study. JACC Cardiovasc Interv. 2018;11(16):1642–50.

    Article  Google Scholar 

  34. Zahn EM, Chang JC, Armer D, Garg R. First human implant of the Alterra Adaptive Prestent (TM): a new self-expanding device designed to remodel the right ventricular outflow tract. Catheter Cardiovasc Interv. 2018;91(6):1125–9.

    Article  Google Scholar 

  35. Gillespie MJ, Rome JJ, Levi DS, Williams RJ, Rhodes JF, Cheatham JP, et al. Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience. Circ Cardiovasc Interv. 2012;5(6):862–70.

    Article  Google Scholar 

  36. Kenny D, Hijazi ZM, Kar S, Rhodes J, Mullen M, Makkar R, et al. Percutaneous implantation of the Edwards SAPIEN transcatheter heart valve for conduit failure in the pulmonary position: early phase 1 results from an international multicenter clinical trial. J Am Coll Cardiol. 2011;58(21):2248–56.

    Article  Google Scholar 

  37. Cheatham SL, Holzer RJ, Chisolm JL, Cheatham JP. The Medtronic Melody(R) transcatheter pulmonary valve implanted at 24-mm diameter--it works. Catheter Cardiovasc Interv. 2013;82(5):816–23.

    Article  Google Scholar 

  38. Kahlert P, Parohl N, Albert J, Schafer L, Reinhardt R, Kaiser GM, et al. Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine. J Cardiovasc Magn Reson. 2012;14:21.

    Article  Google Scholar 

  39. Tzifa A, Krombach G, Kramer N, Kruger S, Schutte A, von Walter M, et al. Magnetic resonance-guided cardiac interventions using magnetic resonance-compatible devices: a preclinical study and first-in-man congenital interventions. Circ Cardiovasc Interv. 2010;3:585–2.

    Article  Google Scholar 

  40. Basar B, Rogers T, Ratnayaka K, Campbell-Washburn AE, Mazal JR, Schenke WH, et al. Segmented nitinol guidewires with stiffness-matched connectors for cardiovascular magnetic resonance catheterization: preserved mechanical performance and freedom from heating. J Cardiovasc Magn Reson. 2015;17(1):105.

    Article  Google Scholar 

  41. Campbell-Washburn AE, Rogers T, Stine AM, Khan JM, Ramasawmy R, Schenke WH, et al. Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience. J Cardiovasc Magn Reson. 2018;20(1):41.

    Article  Google Scholar 

  42. Ratnayaka K, Raman VK, Faranesh AZ, Sonmez M, Kim JH, Gutierrez LF, et al. Antegrade percutaneous closure of membranous ventricular septal defect using X-ray fused with magnetic resonance imaging. JACC Cardiovasc Interv. 2009;2(3):224–30.

    Article  Google Scholar 

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All authors contributed to the study design, data analysis, and/or manuscript preparation. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Toby Rogers.

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Conflict of Interest

Toby Rogers is a Consultant and Physician Proctor to Medtronic and a Physician Proctor to Edwards Lifesciences.

Kanishka Ratnayaka declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiac Magnetic Resonance

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Rogers, T., Ratnayaka, K. CMR in Transcatheter Valve Interventions: State of the Art and Future Directions. Curr Cardiovasc Imaging Rep 12, 13 (2019). https://doi.org/10.1007/s12410-019-9486-4

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  • DOI: https://doi.org/10.1007/s12410-019-9486-4

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