Transcatheter Mitral Valve Planning and the Neo-LVOT: Utilization of Virtual Simulation Models and 3D Printing
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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.
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.
KeywordsNeo-LVOT Procedural planning Transcatheter mitral valve replacement Transcatheter mitral valve implantation TMVI TMVR 3D printing
Compliance with Ethical Standards
Conflict of Interest
Zhenglun Alan Wei, Ajit P. Yoganathan, and John N. Oshinski each declare no potential conflicts of interest.
Keshav Kohli is a consultant to Abbott Laboratories.
Jonathon Leipsic is a consultant to Heartflow and Circle Cardiovascular Imaging.
Philipp Blanke is a consultant to Edwards Lifesciences, Tendyne, Neovasc, and Circle Cardiovascular Imaging.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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