Sengupta Aditya, Alexis Sophia L, Zaid Syed, Tang Gilbert H L, Lerakis Stamatios, Martin Randolph P
Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA.
Department of Cardiology, Heart and Vascular Institute, Westchester Medical Center, Valhalla, New York, NY, USA.
Ann Cardiothorac Surg. 2021 Jan;10(1):28-42. doi: 10.21037/acs-2020-mv-16.
Transcatheter mitral valve interventions (TMVI) have evolved over the past decade as alternatives to open surgical repair for the therapeutic management of patients with severe mitral regurgitation (MR). Concurrent with the development of these technologies, quality multi-modality cardiac imaging has become essential in patient selection and procedural guidance. The former involves assessments of the pathophysiologic mechanisms of regurgitation, valvular anatomy and morphology, as well as objective quantification of the severity of MR. Both transthoracic and transesophageal echocardiography (TEE) are crucial and serve as the gateway to diagnosis and management of mitral valvular disease. Along with multi-detector computed tomography (CT) and cardiac magnetic resonance imaging (CMR), echocardiography plays an important role for preprocedural planning and evaluation of the spatial relationships of the mitral valvular complex with the coronary sinus, circumflex coronary artery and left ventricular (LV) outflow tract. Procedures that target mitral leaflets (e.g., MitraClip, PASCAL) or annulus (e.g., Cardioband, Carillon), or provide chordal (e.g., NeoChord, Harpoon) or valvular replacement, tend to be guided by TEE and assisted by fluoroscopy. As newer devices become available and outcomes of TMVI improve, cardiac imaging will undoubtedly continue to play an essential role in the success of percutaneous mitral valve repair (MVr) and replacement. The interventional surgeon of the future must therefore have a thorough understanding of the various imaging modalities while synthesizing and integrating novel concepts (e.g., neo-LV outflow tract) as applicable to assessing valvular function and pathology.
经导管二尖瓣介入治疗（TMVI）在过去十年中不断发展，已成为严重二尖瓣反流（MR）患者治疗管理中开胸手术修复的替代方案。随着这些技术的发展，高质量的多模态心脏成像对于患者选择和手术指导变得至关重要。前者包括对反流的病理生理机制、瓣膜解剖结构和形态的评估，以及对MR严重程度的客观量化。经胸超声心动图和经食管超声心动图（TEE）都至关重要，是二尖瓣疾病诊断和管理的切入点。与多排计算机断层扫描（CT）和心脏磁共振成像（CMR）一起，超声心动图在术前规划以及评估二尖瓣复合体与冠状窦、回旋支冠状动脉和左心室（LV）流出道的空间关系方面发挥着重要作用。针对二尖瓣叶（如MitraClip、PASCAL）或瓣环（如Cardioband、Carillon），或提供腱索（如NeoChord、Harpoon）或瓣膜置换的手术，往往由TEE引导并辅以荧光透视。随着更新的设备问世以及TMVI结果的改善，心脏成像无疑将继续在经皮二尖瓣修复（MVr）和置换的成功中发挥重要作用。因此，未来的介入外科医生必须全面了解各种成像模式，同时综合并整合适用于评估瓣膜功能和病理的新概念（如neo-LV流出道）。
