CT Imaging for Mitral Valve Surgery and Intervention

Figures

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  Fig. 1. Saddle-shaped annulus. The lateral trigone (blue dot), medial trigone (green dot), anterior horn (white line), and posterior horn (red line) as seen on CT volume rendering (A) postero-superior view and (B) Left lateral view of a 49-year-old man with mitral valve prolapse. Ao = aorta, LCC = left coronary cusp, LV = left ventricle, NCC = noncoronary cusp, RA = right atrium, RV = right ventricle

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  Fig. 2. Mitral annulus and fibrous trigone. The lateral (blue arrow) and medial (green arrow) trigones define the border between the anterior circumference (aortic peak) and posterior circumference (posterior peak). The trigones have a characteristic triangular shape on the en-face view on CT imaging. Mitral prolapse in a 49-year-old man (same patient as Fig. 1).

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  Fig. 3. Mitral leaflet anatomy. The LAA and LCx (arrows) are located near the lateral commissure of the MV. A 70-year-old man with atrial fibrillation and functional mitral regurgitation. A. The surgeon's view can be generated using a slab of the mitral annular plane (yellow box on the 3-chamber view). B. The MV appears open on the diastolic image. C. The MV appears closed on the systolic image. A = anterior scallop, Ao = aorta, LA = left atrium, LAA = left atrial appendage, LCx = left circumflex coronary artery, MV = mitral valve, P = posterior scallop

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  Fig. 4. Papillary muscle visualization on CT and echocardiography. A–C. Volume rendering (A) and short-axis CT images (B) showing the anterolateral (letter A) and posteromedial (letter P) papillary muscles. The base of the papillary muscle, accessory papillary muscle (asterisks), and the prominent trabeculation (arrows) around the papillary muscles are better seen on CT, compared with transthoracic echocardiography (C). A = anterior scallop, LA = left atrium, P = posterior scallop

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  Fig. 5. Localization of a MV prolapse on CT. A. The anterior or posterior leaflet can be defined on the sagittal view of the mitral annular plane. B. Medial, middle, or lateral scallop prolapse can be defined on the coronal view of the mitral annular plane. The LAA and LCx can be used as anatomical landmarks for the lateral commissure. A = anterior scallop, Ao = aorta, CS = coronary sinus, LAA = left atrial appendage, LCx = left circumflex coronary artery, MV = mitral valve, P = posterior scallop C. The surgeon's view can depict the extent of the prolapsed scallop (green arrows) intuitively, using the volume rendering technique. A 40-year-old man with an A1 scallop prolapse. D. Intraoperative findings before and after MV repair. A = anterior scallop, Ao = aorta, LAA = left atrial appendage, MV = mitral valve, P = posterior scallop

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  Fig. 6. Two-dimension based D-shaped mitral annulus evaluation method. The intercommissural distance (yellow line), septal-lateral distance (orange line), and trigone-trigone distance (red line) can be measured on CT imaging as crossing the posterior mitral annulus and bilateral fibrous trigones (blue dot, lateral trigone; green dot, medial trigone). MV = mitral valve