CMR in Aortic and Mitral Valves Structural Intervention-CMR in Aortic and Mitral Valves Structural Intervention

Video Transcription

Video Summary

The Society for Cardiovascular Magnetic Resonance webinar examined CMR’s role in aortic and mitral valve interventions, with presentations on flow measurement, regurgitation assessment, TAVR planning, and paravalvular leak (PVL).<br /><br />Dr. Deya Al Ghatib reviewed phase-contrast flow acquisition and troubleshooting. Accurate results depend on careful plane placement, appropriate velocity encoding (VENC), short echo time, temporal resolution, gating, and meticulous contouring. For aortic stenosis, an LVOT flow plane can complement the usual ascending-aorta measurement; for aortic regurgitation, positioning the plane near the valve helps avoid underestimation. Background phase errors and disagreement between flow and ventricular stroke volumes should prompt quality checks. 4D flow may address some planning and valve-motion limitations, though it does not eliminate errors related to VENC, background phase, or resolution.<br /><br />Dr. Carlos El-Tallawi discussed CMR quantification of mitral and aortic regurgitation, including methods, mechanisms, and effects on cardiac chambers. He emphasized interpreting regurgitant volume and fraction in context, accounting for prolapse volume in Barlow’s disease, and recognizing that combined moderate aortic and mitral regurgitation can impose substantial ventricular volume load.<br /><br />Dr. Amro Alsaid described non-contrast CMR for TAVR sizing and PVL assessment. CMR can provide reliable valve measurements, but calcium assessment remains a key limitation, so non-contrast CT is often complementary. For PVL, a regurgitant fraction around 30% is a meaningful prognostic threshold, while some centers use lower thresholds. 4D flow can help localize and quantify multiple jets.<br /><br />In discussion, speakers agreed echocardiography remains preferred for routine aortic stenosis assessment, while CMR is valuable when echo findings are limited or discordant.

Keywords

cardiovascular magnetic resonance

CMR

aortic valve interventions

mitral valve interventions

phase-contrast flow

regurgitation assessment

TAVR planning

paravalvular leak

4D flow

aortic regurgitation

mitral regurgitation