Imaging of the mitral valve: role of echocardiography, cardiac magnetic resonance, and cardiac computed tomography

Purpose of review This article reviews the role of multimodality imaging in the in evaluation of patients with mitral regurgitation referred for transcatheter interventions. Recent findings Transcatheter therapies for mitral regurgitation in patients with high surgical risk or contraindications for surgery are evolving rapidly. Three-dimensional imaging techniques (transesophageal echocardiography, computed tomography, and cardiovascular magnetic resonance) are key to determine the anatomical suitability for each transcatheter therapy, to accurately quantify mitral regurgitation, and to plan and guide the procedure. Fusion imaging is being implemented in catheterization laboratories to precisely guide the procedure and to maximize safety and optimal results. Transcatheter edge-to-edge mitral valve repair with the MitraClip device (Abbott Vascular, Santa Clara, CA) provides the largest evidence on the safety and efficacy of this minimally invasive therapy and the importance of accurate patient selection to improve outcomes has been recently shown in two randomized trials. Summary Multimodality imaging is key in the work-up of patient with mitral regurgitation undergoing transcatheter therapies. Preprocedural imaging with three-dimensional echocardiography, computed tomography, and cardiac magnetic resonance is important to evaluate the eligibility of patients for transcatheter interventions, whilst three-dimensional transesophageal echocardiography provides soft-tissue information that can be overlaid onto fluoroscopy allowing more accurate guidance of transcatheter interventions.