| Modality . | Advantages . | Disadvantages . |
|---|---|---|
| CT | 1. Aid identification of paravalvular pathology | 1. Radiation exposure and not usable in patients with iodine allergy |
| 2. Detailed assessment of valve thickness, calcification, and annular fibrosis | ||
| 3. For pre-operative evaluation before mitral valve repair and can help predict clinical outcomes | ||
| 4. CT may be preferable to echo for follow-up imaging after mitral valve repair due to enhanced special resolution and reduced interference from metal artefact | ||
| 5. Useful in patients with poor echo windows | ||
| 6. Can identify insufficient coaptation of aortic valve leaflets and pathognomonic central regurgitation | ||
| CMR | 1. Beneficial in assessing the impact of RHD on cardiac function and can be utilized to determine the aetiology of left ventricular dysfunction and aid quantification of regurgitant volumes | 1. Concurrent cardiac arrhythmias may impact image quality and MR assessment on CMRI |
| 2. CMRI may be utilized in the assessment of MS severity with planimetric MVA measurements | 2. Expensive modality and not widely available | |
| 3. CMRI can demonstrate favourable cardiac remodelling following balloon mitral valvuloplasty | ||
| 4. CMRI to accurately estimate LV myocardial fibrosis may also be used in the prognostic assessment of morbidity in RHD patients following surgery | ||
| 5. CMRI allows for detailed assessment and evaluation of regurgitant valves without systematic overestimating | ||
| 6. Advantage of CMRI over echocardiography is the capability to calculate MR severity regardless of the regurgitant jet shape or direction | ||
| Three-dimensional Echocardiography | 1. More accurate than conventional 2D imaging at assessing suitability for valve surgery | 1. Expensive |
| 2. Used to assess TR severity and progression pre- and post-mitral valve replacement | 2. Requires special training | |
| 3. The 3D TOE can help clarify the MVA by planimetry where transthoracic images are suboptimal | ||
| 4. Post-surgical right ventricle assessment is more accurate | ||
| TOE | 1. Can help clarify disease mechanisms or severity where this is unclear | 1. Uncomfortable for patients not under anaesthetic |
| 2. Helps aid intervention planning including excluding left atrial appendage thrombus prior to percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and clarifying suitability for valve repair or replacement | 2. Not repeatable for regular follow-up | |
| 3. TOE has also been used to look at results post for paravalvular leak | 3. Expensive | |
| 4. Useful for evaluation during surgery and is especially useful for minimally invasive surgery |
| Modality . | Advantages . | Disadvantages . |
|---|---|---|
| CT | 1. Aid identification of paravalvular pathology | 1. Radiation exposure and not usable in patients with iodine allergy |
| 2. Detailed assessment of valve thickness, calcification, and annular fibrosis | ||
| 3. For pre-operative evaluation before mitral valve repair and can help predict clinical outcomes | ||
| 4. CT may be preferable to echo for follow-up imaging after mitral valve repair due to enhanced special resolution and reduced interference from metal artefact | ||
| 5. Useful in patients with poor echo windows | ||
| 6. Can identify insufficient coaptation of aortic valve leaflets and pathognomonic central regurgitation | ||
| CMR | 1. Beneficial in assessing the impact of RHD on cardiac function and can be utilized to determine the aetiology of left ventricular dysfunction and aid quantification of regurgitant volumes | 1. Concurrent cardiac arrhythmias may impact image quality and MR assessment on CMRI |
| 2. CMRI may be utilized in the assessment of MS severity with planimetric MVA measurements | 2. Expensive modality and not widely available | |
| 3. CMRI can demonstrate favourable cardiac remodelling following balloon mitral valvuloplasty | ||
| 4. CMRI to accurately estimate LV myocardial fibrosis may also be used in the prognostic assessment of morbidity in RHD patients following surgery | ||
| 5. CMRI allows for detailed assessment and evaluation of regurgitant valves without systematic overestimating | ||
| 6. Advantage of CMRI over echocardiography is the capability to calculate MR severity regardless of the regurgitant jet shape or direction | ||
| Three-dimensional Echocardiography | 1. More accurate than conventional 2D imaging at assessing suitability for valve surgery | 1. Expensive |
| 2. Used to assess TR severity and progression pre- and post-mitral valve replacement | 2. Requires special training | |
| 3. The 3D TOE can help clarify the MVA by planimetry where transthoracic images are suboptimal | ||
| 4. Post-surgical right ventricle assessment is more accurate | ||
| TOE | 1. Can help clarify disease mechanisms or severity where this is unclear | 1. Uncomfortable for patients not under anaesthetic |
| 2. Helps aid intervention planning including excluding left atrial appendage thrombus prior to percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and clarifying suitability for valve repair or replacement | 2. Not repeatable for regular follow-up | |
| 3. TOE has also been used to look at results post for paravalvular leak | 3. Expensive | |
| 4. Useful for evaluation during surgery and is especially useful for minimally invasive surgery |
CMR, cardiac magnetic resonance; CMRI, cardiac magnetic resonance imaging; CT, computed tomography; MR, mitral regurgitation; MS, mitral stenosis; MVA, mitral valve area; RHD, rheumatic heart disease; TOE, transoesophageal echocardiography; TR, tricuspid regurgitation.
| Modality . | Advantages . | Disadvantages . |
|---|---|---|
| CT | 1. Aid identification of paravalvular pathology | 1. Radiation exposure and not usable in patients with iodine allergy |
| 2. Detailed assessment of valve thickness, calcification, and annular fibrosis | ||
| 3. For pre-operative evaluation before mitral valve repair and can help predict clinical outcomes | ||
| 4. CT may be preferable to echo for follow-up imaging after mitral valve repair due to enhanced special resolution and reduced interference from metal artefact | ||
| 5. Useful in patients with poor echo windows | ||
| 6. Can identify insufficient coaptation of aortic valve leaflets and pathognomonic central regurgitation | ||
| CMR | 1. Beneficial in assessing the impact of RHD on cardiac function and can be utilized to determine the aetiology of left ventricular dysfunction and aid quantification of regurgitant volumes | 1. Concurrent cardiac arrhythmias may impact image quality and MR assessment on CMRI |
| 2. CMRI may be utilized in the assessment of MS severity with planimetric MVA measurements | 2. Expensive modality and not widely available | |
| 3. CMRI can demonstrate favourable cardiac remodelling following balloon mitral valvuloplasty | ||
| 4. CMRI to accurately estimate LV myocardial fibrosis may also be used in the prognostic assessment of morbidity in RHD patients following surgery | ||
| 5. CMRI allows for detailed assessment and evaluation of regurgitant valves without systematic overestimating | ||
| 6. Advantage of CMRI over echocardiography is the capability to calculate MR severity regardless of the regurgitant jet shape or direction | ||
| Three-dimensional Echocardiography | 1. More accurate than conventional 2D imaging at assessing suitability for valve surgery | 1. Expensive |
| 2. Used to assess TR severity and progression pre- and post-mitral valve replacement | 2. Requires special training | |
| 3. The 3D TOE can help clarify the MVA by planimetry where transthoracic images are suboptimal | ||
| 4. Post-surgical right ventricle assessment is more accurate | ||
| TOE | 1. Can help clarify disease mechanisms or severity where this is unclear | 1. Uncomfortable for patients not under anaesthetic |
| 2. Helps aid intervention planning including excluding left atrial appendage thrombus prior to percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and clarifying suitability for valve repair or replacement | 2. Not repeatable for regular follow-up | |
| 3. TOE has also been used to look at results post for paravalvular leak | 3. Expensive | |
| 4. Useful for evaluation during surgery and is especially useful for minimally invasive surgery |
| Modality . | Advantages . | Disadvantages . |
|---|---|---|
| CT | 1. Aid identification of paravalvular pathology | 1. Radiation exposure and not usable in patients with iodine allergy |
| 2. Detailed assessment of valve thickness, calcification, and annular fibrosis | ||
| 3. For pre-operative evaluation before mitral valve repair and can help predict clinical outcomes | ||
| 4. CT may be preferable to echo for follow-up imaging after mitral valve repair due to enhanced special resolution and reduced interference from metal artefact | ||
| 5. Useful in patients with poor echo windows | ||
| 6. Can identify insufficient coaptation of aortic valve leaflets and pathognomonic central regurgitation | ||
| CMR | 1. Beneficial in assessing the impact of RHD on cardiac function and can be utilized to determine the aetiology of left ventricular dysfunction and aid quantification of regurgitant volumes | 1. Concurrent cardiac arrhythmias may impact image quality and MR assessment on CMRI |
| 2. CMRI may be utilized in the assessment of MS severity with planimetric MVA measurements | 2. Expensive modality and not widely available | |
| 3. CMRI can demonstrate favourable cardiac remodelling following balloon mitral valvuloplasty | ||
| 4. CMRI to accurately estimate LV myocardial fibrosis may also be used in the prognostic assessment of morbidity in RHD patients following surgery | ||
| 5. CMRI allows for detailed assessment and evaluation of regurgitant valves without systematic overestimating | ||
| 6. Advantage of CMRI over echocardiography is the capability to calculate MR severity regardless of the regurgitant jet shape or direction | ||
| Three-dimensional Echocardiography | 1. More accurate than conventional 2D imaging at assessing suitability for valve surgery | 1. Expensive |
| 2. Used to assess TR severity and progression pre- and post-mitral valve replacement | 2. Requires special training | |
| 3. The 3D TOE can help clarify the MVA by planimetry where transthoracic images are suboptimal | ||
| 4. Post-surgical right ventricle assessment is more accurate | ||
| TOE | 1. Can help clarify disease mechanisms or severity where this is unclear | 1. Uncomfortable for patients not under anaesthetic |
| 2. Helps aid intervention planning including excluding left atrial appendage thrombus prior to percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and clarifying suitability for valve repair or replacement | 2. Not repeatable for regular follow-up | |
| 3. TOE has also been used to look at results post for paravalvular leak | 3. Expensive | |
| 4. Useful for evaluation during surgery and is especially useful for minimally invasive surgery |
CMR, cardiac magnetic resonance; CMRI, cardiac magnetic resonance imaging; CT, computed tomography; MR, mitral regurgitation; MS, mitral stenosis; MVA, mitral valve area; RHD, rheumatic heart disease; TOE, transoesophageal echocardiography; TR, tricuspid regurgitation.
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