Baessato Francesca, Ruzzarin Alessandro, Meierhofer Christian
Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, TUM University Hospital, Technical University of Munich, School of Medicine and Health, Munich, Germany.
Department of Cardiology, Regional Hospital S. Maurizio, Bolzano, Italy.
Cardiovasc Diagn Ther. 2025 Apr 30;15(2):441-454. doi: 10.21037/cdt-24-470. Epub 2025 Apr 23.
Valvular heart diseases (VHDs) require definition of anatomy, severity, and risk stratification to best define procedural need, type of intervention and seriate follow-up. Congenital lesions are much rarer and often associated with more complex lesions. Among noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) represents a fundamental tool for complete assessment and quantification of VHDs. CMR can provide wide anatomical views on cardiac and extra-cardiac structures in any plane orientation, flow and volume quantification, as well as information on ventricular remodeling and viability. In the context of valve stenosis, quantification by CMR is based primarily on direct measurement of valve orifice at maximal valve opening, although CMR data remain less reliable than standard echocardiography due to reduced temporal resolution. Definition of great vessels anatomy by CMR can allow differentiation of valvular, subvalvular or supravalvular lesions. For valve regurgitation, CMR is the gold standard for quantification of ventricular volumes and function and for direct calculation of regurgitation of the semilunar valves with through-plane phase-contrast images. Additional flow measurements can be integrated to cross-check quantitative data on great vessels flow and stroke volumes. A standardized approach is recommended in CMR studies. A minimum CMR dataset should include two-dimensional cine and phase-contrast sequences, and three-dimensional whole heart imaging. This should be applied in the clinical practice to assess VHDs, including most complex congenital lesions.
心脏瓣膜病（VHDs）需要明确解剖结构、严重程度和风险分层，以最佳地确定手术需求、干预类型和系列随访。先天性病变更为罕见，且常与更复杂的病变相关。在非侵入性成像方式中，心血管磁共振（CMR）是全面评估和量化VHDs的基本工具。CMR可以在任何平面方向上提供心脏和心脏外结构的广泛解剖视图、血流和容积量化，以及关于心室重塑和存活能力的信息。在瓣膜狭窄的情况下，CMR量化主要基于在瓣膜最大开放时直接测量瓣口面积，尽管由于时间分辨率降低，CMR数据的可靠性低于标准超声心动图。通过CMR定义大血管解剖结构可以区分瓣膜、瓣膜下或瓣膜上病变。对于瓣膜反流，CMR是量化心室容积和功能以及通过平面相位对比图像直接计算半月瓣反流的金标准。可以整合额外的血流测量来交叉核对大血管血流和每搏量的定量数据。在CMR研究中建议采用标准化方法。最小的CMR数据集应包括二维电影和相位对比序列以及三维全心成像。这应应用于临床实践中评估VHDs，包括最复杂的先天性病变。
