Korean J Radiol.  2019 Mar;20(3):352-363. 10.3348/kjr.2018.0350.

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

• Suh YJ
• Lee S
• Chang BC
• Shim CY
• Hong GR
• Choi BW
• Kim YJ

• KMID: 2438265
• DOI: http://doi.org/10.3348/kjr.2018.0350

Abstract

OBJECTIVE
We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings.
MATERIALS AND METHODS
A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement.
RESULTS
During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05).
CONCLUSION
Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.

Keyword

Mitral regurgitation; Mitral valve prolapse; Computed tomography; Mitral valve surgery; Preoperative planning

MeSH Terms

Calcium
Humans
Logistic Models
Mitral Valve Insufficiency*
Mitral Valve Prolapse
Mitral Valve*
Odds Ratio
Prolapse
Retrospective Studies
Sensitivity and Specificity
Calcium

Figure

• 

  Fig. 1 Flowchart of study population.CT = computed tomography, MR = mitral regurgitation, MV = mitral valve

• 

  Fig. 2 CT images of repairable MV in 70-year-old female patient with degenerative MR.Short-axis CT image of MV (A), CT images parallel to (B) and perpendicular to intercommissural axis (C), and three-dimensional volume-rendered image from surgeon's view (D), showing prolapse of P2 scallop (arrow) without leaflet thickening or calcification, or mitral annular calcification. Patient underwent MV repair with ring annuloplasty. Ao = aorta, LAA = left atrial appendage

• 

  Fig. 3 CT images of non-repairable MV in 46-year-old female patient showing bi-leaflet prolapse and leaflet thickening.A, B. CT images of MV show bi-leaflet prolapse (arrows) and leaflet thickening. C. Three-dimensional volume-rendered image from surgeon's view shows prolapse of both leaflets. Patient underwent MV replacement with tissue valve.

• 

  Fig. 4 CT images of non-repairable MV in 77-year-old female patient with degenerative MR, showing anterior leaflet prolapse, MV leaflet thickening and calcification, and mitral annular calcification.(A, B) Short-axis CT images of MV show severe mitral annular calcification (arrows) and leaflet thickening. CT images parallel to (C) and perpendicular to intercommissural axis (D), and three-dimensional volume-rendered image of surgeon's view (E) shows prolapse of A1 and A3 scallops, thickening of MV leaflets, and leaflet calcification (arrow). Patient underwent MV replacement with tissue valve.

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