Role of Computed Tomography in Pre-Procedural Planning of Transcatheter Mitral Valve Replacement

Transcatheter heart valve (THV) replacement is growing rapidly worldwide. Transcatheter aortic valve replacement (TAVR) is the treatment of choice in severe symptomatic aortic stenosis in patients considered to be at high and intermediate surgical risk. Building on the continued success of TAVR, transcatheter mitral valve replacement (TMVR) is rapidly evolving and several devices are under investigation. Multidetector computed tomography (MDCT), with its high spatial resolution and ability for multiplanar reformatting, has become the standard imaging modality in pre-procedural assessment. MDCT provides detailed delineation of valvular anatomy and therefore provides the basis for device sizing and selection. In addition, there are growing data supporting the role of pre-procedural CT in risk assessment and prediction of complications in patients undergoing THV replacement. In TMVR, CT is being used to assist with annular sizing as well as the discrimination of complication and risk including left ventricular outflow tract obstruction. We herein aim to review the growing role of MDCT in the evaluation of patients being considered for TMVR.