HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text AVI movie Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alkadhi, H. Articles by Boehm, T. Search for Related Content PubMed PubMed Citation Articles by Alkadhi, H. Articles by Boehm, T.

Mitral Regurgitation: Quantification with 16–Detector Row CT—Initial Experience¹

¹ From the Institute of Diagnostic Radiology (H.A., S.W., B.B., S.L., L.M.D., B.M., T.B.), Institute of Anesthesia, Division of Cardiovascular Anesthesia (D.A.B.), and Clinic for Cardiovascular Surgery (A.P.), University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Received December 31, 2004; revision requested March 3, 2005; revision received March 15; final version accepted April 15. Supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions, of the Swiss National Science Foundation. Address correspondence to H.A. (e-mail: hatem.alkadhi{at}usz.ch).

View larger version (20K): [in a new window]   Figure 1a: (a) Scatterplot of data regarding severity of mitral regurgitation at TEE and planimetric ROA measurements at multi–detector row CT (MDCT) shows the high degree of correlation between the two variables. (b) Scatterplot of data regarding severity of mitral regurgitation at ventriculography and planimetric ROA measurements at multi–detector row CT shows the high degree of correlation between the two variables. n = Number of patients with mitral regurgitation.

View larger version (19K): [in a new window]   Figure 1b: (a) Scatterplot of data regarding severity of mitral regurgitation at TEE and planimetric ROA measurements at multi–detector row CT (MDCT) shows the high degree of correlation between the two variables. (b) Scatterplot of data regarding severity of mitral regurgitation at ventriculography and planimetric ROA measurements at multi–detector row CT shows the high degree of correlation between the two variables. n = Number of patients with mitral regurgitation.

View larger version (180K): [in a new window]   Figure 2a: (a) Oblique CT image through long axis of LV and LA during systole (at 5% of the R-R interval) in 53-year-old man shows incomplete coaptation of the anterior and posterior mitral valve leaflets that creates a regurgitant orifice (arrowheads). Inset: Reconstruction perpendicular to the regurgitant orifice shows the ROA (arrowheads); planimetric measurements indicated that the ROA was 15 mm2. (b) Corresponding TEE image in two-chamber view at 90° similarly shows the incompetent valve closure (arrowheads) during systole. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered mild (grade 1) in this patient. (c) Ventriculogram in 60° left anterior oblique projection shows flow of contrast medium (arrowheads) into the LA during systole; this mitral regurgitation was considered mild (grade 1).

View larger version (133K): [in a new window]   Figure 2b: (a) Oblique CT image through long axis of LV and LA during systole (at 5% of the R-R interval) in 53-year-old man shows incomplete coaptation of the anterior and posterior mitral valve leaflets that creates a regurgitant orifice (arrowheads). Inset: Reconstruction perpendicular to the regurgitant orifice shows the ROA (arrowheads); planimetric measurements indicated that the ROA was 15 mm2. (b) Corresponding TEE image in two-chamber view at 90° similarly shows the incompetent valve closure (arrowheads) during systole. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered mild (grade 1) in this patient. (c) Ventriculogram in 60° left anterior oblique projection shows flow of contrast medium (arrowheads) into the LA during systole; this mitral regurgitation was considered mild (grade 1).

View larger version (138K): [in a new window]   Figure 2c: (a) Oblique CT image through long axis of LV and LA during systole (at 5% of the R-R interval) in 53-year-old man shows incomplete coaptation of the anterior and posterior mitral valve leaflets that creates a regurgitant orifice (arrowheads). Inset: Reconstruction perpendicular to the regurgitant orifice shows the ROA (arrowheads); planimetric measurements indicated that the ROA was 15 mm2. (b) Corresponding TEE image in two-chamber view at 90° similarly shows the incompetent valve closure (arrowheads) during systole. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered mild (grade 1) in this patient. (c) Ventriculogram in 60° left anterior oblique projection shows flow of contrast medium (arrowheads) into the LA during systole; this mitral regurgitation was considered mild (grade 1).

View larger version (172K): [in a new window]   Figure 3a: (a) Oblique CT image through long axis of LV and LA in 66-year-old man shows incompetent mitral valve closure during systole (at 10% of the R-R interval); the leaflets create a regurgitant orifice (arrowheads). Note the thickened tendinous cords (arrows) and the thickened free margin of the anterior leaflet. Inset: Perpendicular reconstruction clearly shows the regurgitant orifice (arrowheads); planimetric measurements indicated that the ROA was 46 mm2. (b) TEE image in four-chamber view at 0° similarly shows the incomplete coaptation (arrowheads), thickened tendinous cords (arrows), and thickened leaflets. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered moderate (grade 2) in this patient. (c) Ventriculogram obtained in 60° left anterior oblique projection shows contrast medium backflow (arrowheads) from the LV into the LA during systole; this mitral regurgitation was considered moderately severe (grade 3).

View larger version (145K): [in a new window]   Figure 3b: (a) Oblique CT image through long axis of LV and LA in 66-year-old man shows incompetent mitral valve closure during systole (at 10% of the R-R interval); the leaflets create a regurgitant orifice (arrowheads). Note the thickened tendinous cords (arrows) and the thickened free margin of the anterior leaflet. Inset: Perpendicular reconstruction clearly shows the regurgitant orifice (arrowheads); planimetric measurements indicated that the ROA was 46 mm2. (b) TEE image in four-chamber view at 0° similarly shows the incomplete coaptation (arrowheads), thickened tendinous cords (arrows), and thickened leaflets. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered moderate (grade 2) in this patient. (c) Ventriculogram obtained in 60° left anterior oblique projection shows contrast medium backflow (arrowheads) from the LV into the LA during systole; this mitral regurgitation was considered moderately severe (grade 3).

View larger version (123K): [in a new window]   Figure 3c: (a) Oblique CT image through long axis of LV and LA in 66-year-old man shows incompetent mitral valve closure during systole (at 10% of the R-R interval); the leaflets create a regurgitant orifice (arrowheads). Note the thickened tendinous cords (arrows) and the thickened free margin of the anterior leaflet. Inset: Perpendicular reconstruction clearly shows the regurgitant orifice (arrowheads); planimetric measurements indicated that the ROA was 46 mm2. (b) TEE image in four-chamber view at 0° similarly shows the incomplete coaptation (arrowheads), thickened tendinous cords (arrows), and thickened leaflets. Inset: Color Doppler echocardiogram shows a jet (arrowheads) regurgitating into the LA; mitral regurgitation was considered moderate (grade 2) in this patient. (c) Ventriculogram obtained in 60° left anterior oblique projection shows contrast medium backflow (arrowheads) from the LV into the LA during systole; this mitral regurgitation was considered moderately severe (grade 3).

View larger version (164K): [in a new window]   Figure 4a: (a) Oblique CT image through long axis of LV and LA during systole (at 10% of the R-R interval) in 58-year-old woman shows incompetent coaptation (arrowheads) and billowing of both leaflets (arrows); this appearance defines valve prolapse. Inset: Perpendicular reconstruction shows the 65-mm2 regurgitant orifice (arrowheads). (b) TEE image in commissural view at 60° similarly shows the incomplete valve closure (arrowheads) and prolapse of both leaflets (arrows). Inset: Color Doppler echocardiogram shows a substantial regurgitant jet (arrowheads) that creates turbulent flow in the LA; mitral regurgitation was consequently considered severe (grade 3). (c) Ventriculogram in 60° left anterior oblique projection shows contrast material backflow during systole into the LA (white arrowheads) and pulmonary veins (black arrowheads)—findings consistent with severe (grade 4) regurgitation.

View larger version (119K): [in a new window]   Figure 4b: (a) Oblique CT image through long axis of LV and LA during systole (at 10% of the R-R interval) in 58-year-old woman shows incompetent coaptation (arrowheads) and billowing of both leaflets (arrows); this appearance defines valve prolapse. Inset: Perpendicular reconstruction shows the 65-mm2 regurgitant orifice (arrowheads). (b) TEE image in commissural view at 60° similarly shows the incomplete valve closure (arrowheads) and prolapse of both leaflets (arrows). Inset: Color Doppler echocardiogram shows a substantial regurgitant jet (arrowheads) that creates turbulent flow in the LA; mitral regurgitation was consequently considered severe (grade 3). (c) Ventriculogram in 60° left anterior oblique projection shows contrast material backflow during systole into the LA (white arrowheads) and pulmonary veins (black arrowheads)—findings consistent with severe (grade 4) regurgitation.

View larger version (143K): [in a new window]   Figure 4c: (a) Oblique CT image through long axis of LV and LA during systole (at 10% of the R-R interval) in 58-year-old woman shows incompetent coaptation (arrowheads) and billowing of both leaflets (arrows); this appearance defines valve prolapse. Inset: Perpendicular reconstruction shows the 65-mm2 regurgitant orifice (arrowheads). (b) TEE image in commissural view at 60° similarly shows the incomplete valve closure (arrowheads) and prolapse of both leaflets (arrows). Inset: Color Doppler echocardiogram shows a substantial regurgitant jet (arrowheads) that creates turbulent flow in the LA; mitral regurgitation was consequently considered severe (grade 3). (c) Ventriculogram in 60° left anterior oblique projection shows contrast material backflow during systole into the LA (white arrowheads) and pulmonary veins (black arrowheads)—findings consistent with severe (grade 4) regurgitation.

View larger version (179K): [in a new window]   Figure 5a: (a) Oblique CT image through long axis of LV and LA (at 5% of the R-R interval) shows grade I (>2 but 5 mm) calcification of the anterior leaflet (white arrowhead) and grade II (>5 mm) calcification of the posterior mitral annulus (black arrowhead). (b) Corresponding TEE image (two-chamber view at 0°) similarly shows both foci of calcification (white and black arrowheads), which cause acoustic shadowing. (c) Oblique CT reconstruction through long axis of LV and LA shows posterior leaflet prolapse (arrowhead). (d) TEE image (two-chamber view at 0°) similarly shows a flail posterior leaflet (arrowhead) with cordal rupture. A rupture of tendinous cords (as verified during surgery) was suspected but could not be directly demonstrated with CT.

View larger version (153K): [in a new window]   Figure 5b: (a) Oblique CT image through long axis of LV and LA (at 5% of the R-R interval) shows grade I (>2 but 5 mm) calcification of the anterior leaflet (white arrowhead) and grade II (>5 mm) calcification of the posterior mitral annulus (black arrowhead). (b) Corresponding TEE image (two-chamber view at 0°) similarly shows both foci of calcification (white and black arrowheads), which cause acoustic shadowing. (c) Oblique CT reconstruction through long axis of LV and LA shows posterior leaflet prolapse (arrowhead). (d) TEE image (two-chamber view at 0°) similarly shows a flail posterior leaflet (arrowhead) with cordal rupture. A rupture of tendinous cords (as verified during surgery) was suspected but could not be directly demonstrated with CT.

View larger version (187K): [in a new window]   Figure 5c: (a) Oblique CT image through long axis of LV and LA (at 5% of the R-R interval) shows grade I (>2 but 5 mm) calcification of the anterior leaflet (white arrowhead) and grade II (>5 mm) calcification of the posterior mitral annulus (black arrowhead). (b) Corresponding TEE image (two-chamber view at 0°) similarly shows both foci of calcification (white and black arrowheads), which cause acoustic shadowing. (c) Oblique CT reconstruction through long axis of LV and LA shows posterior leaflet prolapse (arrowhead). (d) TEE image (two-chamber view at 0°) similarly shows a flail posterior leaflet (arrowhead) with cordal rupture. A rupture of tendinous cords (as verified during surgery) was suspected but could not be directly demonstrated with CT.

View larger version (129K): [in a new window]   Figure 5d: (a) Oblique CT image through long axis of LV and LA (at 5% of the R-R interval) shows grade I (>2 but 5 mm) calcification of the anterior leaflet (white arrowhead) and grade II (>5 mm) calcification of the posterior mitral annulus (black arrowhead). (b) Corresponding TEE image (two-chamber view at 0°) similarly shows both foci of calcification (white and black arrowheads), which cause acoustic shadowing. (c) Oblique CT reconstruction through long axis of LV and LA shows posterior leaflet prolapse (arrowhead). (d) TEE image (two-chamber view at 0°) similarly shows a flail posterior leaflet (arrowhead) with cordal rupture. A rupture of tendinous cords (as verified during surgery) was suspected but could not be directly demonstrated with CT.