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01.12.2008 | Review | Ausgabe 1/2008 Open Access

Journal of Cardiovascular Magnetic Resonance 1/2008

Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance

Zeitschrift:
Journal of Cardiovascular Magnetic Resonance > Ausgabe 1/2008
Autoren:
KM John Chan, Ricardo Wage, Karen Symmonds, Shelley Rahman-Haley, Raad H Mohiaddin, David N Firmin, John R Pepper, Dudley J Pennell, Philip J Kilner
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1532-429X-10-61) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

KMJC, JRP, DJP and PJK conceived the project. KMJC and PJK developed the imaging protocol and wrote the first and final drafts of the manuscript. RW and KS helped develop and optimise the imaging protocol and performed the imaging scans. DNF helped develop and optimise the imaging protocol. All authors provided scientific contributions, participated in the editing of the manuscript, and read and approved the final draft.

Abstract

Cardiovascular magnetic resonance (CMR) is increasingly used to assess patients with mitral regurgitation. Its advantages include quantitative determination of ventricular volumes and function and the mitral regurgitant fraction, and in ischemic mitral regurgitation, regional myocardial function and viability. In addition to these, identification of leaflet prolapse or restriction is necessary when valve repair is contemplated. We describe a systematic approach to the evaluation of mitral regurgitation using CMR which we have used in 149 patients with varying etiologies and severity of regurgitation over a 15 month period.
Following standard ventricular cine acquisitions, including 2, 3 and 4 chamber long axis views and a short axis stack for biventricular function, we image movements of all parts of the mitral leaflets using a contiguous stack of oblique long axis cines aligned orthogonal to the central part of the line of coaptation. The 8–10 slices in the stack, orientated approximately parallel to a 3-chamber view, are acquired sequentially from the superior (antero-lateral) mitral commissure to the inferior (postero-medial) commissure, visualising each apposing pair of anterior and posterior leaflet scallops in turn (A1-P1, A2-P2 and A3-P3). We use balanced steady state free precession imaging at 1.5 Tesla, slice thickness 5 mm, with no inter-slice gaps. Where the para-commissural coaptation lines curve relative to the central region, two further oblique cines are acquired orthogonal to the line of coaptation adjacent to each commissure. To quantify mitral regurgitation, we use phase contrast velocity mapping to measure aortic outflow, subtracting this from the left ventricular stroke volume to calculate the mitral regurgitant volume which, when divided by the left ventricular stroke volume, gives the mitral regurgitant fraction. In patients with ischemic mitral regurgitation, we further assess regional left ventricular function and, with late gadolinium enhancement, myocardial viability.
Comprehensive assessment of mitral regurgitation using CMR is feasible and enables determination of mitral regurgitation severity, associated leaflet prolapse or restriction, ventricular function and viability in a single examination and is now routinely performed at our centre. The mitral valve stack of images is particularly useful and easy to acquire.
Zusatzmaterial
Additional file 1: Figure 6b (movie). bSSFP cine demonstrating prolapsed P2 with eccentric jet of severe mitral regurgitation directed anteriorly along the wall of the left atrium and extending to its back wall. A central bright jet core is seen with a dark streak of signal loss beyond indicating severe regurgitation. (AVI 16 MB)
Literatur
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