Heart valve disease: investigation by cardiovascular magnetic resonance
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REVIEW
Open Access
Heart valve disease: investigation by cardiovascular magnetic resonance Saul G Myerson
Abstract 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. Keywords: Cardiovascular Magnetic Resonance, Valve disease, Flow quantification
Review Cardiovascular magnetic resonance (CMR) has unique capabilities which can greatly benefit the assessment of the patient with cardiac valve disease. While echocardiography (echo) remains the major imaging modality for assessing valve disease, there are many areas where CMR provides ‘added value’ to existing assessment and can complement the echo assessment. CMR can also provide a comprehensive ‘stand-alone’ assessment in some situations, delivering optimal assessment of patients using a combination of several techniques. These include quantifying the severity of the valve lesion, determining aetiology, examining the consequences for the relevant ventricle, and assessment of the surrounding anatomy (e.g. aortic root). Additional information on great vessel anatomy and the presence of Correspondence: [email protected] Consultant Cardiologist, John Radcliffe Hospital, Honorary Senior Clinical Lecturer, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
myocardial scar (infarction) can also be clinically useful. The modality is used best by harnessing the advantages it brings, rather than attempting to replicate echocardiography or x-ray computed tomography (CT). This review will highlight the o
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