Structural Heart Disease and Guidance of Percutaneous Procedures
Among selected patients, cardiac computed tomography (CT) and magnetic resonance (CMR) emerge as useful tools for the diagnosis, follow-up, and prognosis of patients with native and prosthetic valve disease. These techniques, particularly CMR, allow improved evaluation of ventricular morphology and function, myocardial tissue characterization including patterns and extent of fibrosis, and more accurate evaluation of ventricular volumes (especially relevant for the assessment of the right ventricle). Rather than alternatives to echocardiography, cardiac CT and CMR are complimentary diagnostic tools. Cardiac CT provides unsurpassed anatomic information with nonrestricted volumetric planes and is the reference standard imaging tool for the guidance and follow-up of valvular interventions, aortic endovascular repair, and non-valvular cardiac devices. CMR enables accurate, reproducible, ionizing-free, and usually without requirement of contrast evaluation of valve disease. In particular, CMR can quantify anterograde and retrograde volumes and flow velocities and enables differential diagnosis including specific cardiomyopathies.