Heart valve disease: investigation by cardiovascular magnetic resonance

Cardiovascular magnetic resonance (CMR) has become a valuable investigative tool in many areas of cardiac medicine. Its value in heart valve disease is less well appreciated however, particularly as echocardiography is a powerful and widely available technique in valve disease. This review highlights the added value that CMR can bring in valve disease, complementing echocardiography in many areas, but it has also become the first-line investigation in some, such as pulmonary valve disease and assessing the right ventricle. CMR has many advantages, including the ability to image in any plane, which allows full visualisation of valves and their inflow/outflow tracts, direct measurement of valve area (particularly for stenotic valves), and characterisation of the associated great vessel anatomy (e.g. the aortic root and arch in aortic valve disease). A particular strength is the ability to quantify flow, which allows accurate measurement of regurgitation, cardiac shunt volumes/ratios and differential flow volumes (e.g. left and right pulmonary arteries). Quantification of ventricular volumes and mass is vital for determining the impact of valve disease on the heart, and CMR is the 'Gold standard' for this. Limitations of the technique include partial volume effects due to image slice thickness, and a low ability to identify small, highly mobile objects (such as vegetations) due to the need to acquire images over several cardiac cycles. The review examines the advantages and disadvantages of each imaging aspect in detail, and considers how CMR can be used optimally for each valve lesion

Left ventricular apical diseases

There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features

Theory and Validation of Magnetic Resonance Fluid Motion Estimation Using Intensity Flow Data

15 p.Background Motion tracking based on spatial-temporal radio-frequency signals from the pixel representation of magnetic resonance (MR) imaging of a non-stationary fluid is able to provide two dimensional vector field maps. This supports the underlying fundamentals of magnetic resonance fluid motion estimation and generates a new methodology for flow measurement that is based on registration of nuclear signals from moving hydrogen nuclei in fluid. However, there is a need to validate the computational aspect of the approach by using velocity flow field data that we will assume as the true reference information or ground truth. Methodology/Principal Findings In this study, we create flow vectors based on an ideal analytical vortex, and generate artificial signal-motion image data to verify our computational approach. The analytical and computed flow fields are compared to provide an error estimate of our methodology. The comparison shows that the fluid motion estimation approach using simulated MR data is accurate and robust enough for flow field mapping. To verify our methodology, we have tested the computational configuration on magnetic resonance images of cardiac blood and proved that the theory of magnetic resonance fluid motion estimation can be applicable practically. Conclusions/Significance The results of this work will allow us to progress further in the investigation of fluid motion prediction based on imaging modalities that do not require velocity encoding. This article describes a novel theory of motion estimation based on magnetic resonating blood, which may be directly applied to cardiac flow imaging.Kelvin Kian Loong Wong, Richard Malcolm Kelso, Stephen Grant Worthley, Prashanthan Sanders, Jagannath Mazumdar, Derek Abbot

Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement

Paravalvular aortic regurgitation (PAR) following transcatheter aortic valve implantation (TAVI) is well acknowledged. Despite improvements, echocardiographic measurement of PAR largely remains qualitative. Cardiovascular magnetic resonance (CMR) directly quantifies AR with accuracy and reproducibility. We compared CMR and transthoracic echocardiography (TTE) analysis of pre-operative and post-operative aortic regurgitation in patients undergoing both TAVI and surgical aortic valve replacement (AVR).Gareth Crouch, Phillip J Tully, Jayme Bennetts, Ajay Sinhal, Craig Bradbrook, Amy L Penhall, Carmine G De Pasquale, Robert A Baker, and Joseph B Selvanayaga