CT Imaging Essentials Screening Patients for Mitral Valve

CT Imaging Essentials: Screening Patients for Mitral Valve Repair Dee Wang, MD, FACC, FASE, FSCCT Director Structural Heart Imaging Medical Director 3 D Printing Henry Ford Innovations Institute Associate Professor, Wayne State University School of Medicine Henry Ford Health System dwang 2@hfhs. org @deedeewangmd

Disclosures Grant support: Director CT Core. Lab: MITRAL trial, NIH LAMPOON clinical trial Director Echo Core. Lab: NIH LAMPOON clinical trial Patent(s): co-inventor on a patent application, assigned to employer Henry Ford Health System, on software to predict LVOTO Consultant: Edwards Life. Sciences Materialise Boston Scientific Highlife Medical

Goals Discuss pre-procedural Mitral CT protocol Identify utility of CT in pre-procedure screening Identify role of CT intra-procedural

Why CT?

Interventional Imaging

Dedicated Full-time Interventional Imagers Required skillsets not yet defined, no core competencies Amplified learning curve compared to Implanters Majority of hospitals are not in a “Heart Team” Model Hence, there is significant discrepancy in quality of TEE and surface echo interpretation and acquisition skillsets

Why CT? Reproducible Scalable Less interobserver variability

CSHD CT and CAD Imaging Growth 2013 -2017 1600 1400 1200 1000 800 600 400 200 0 2013 2014 TAVR 2015 Mitral post Tcaval 2016 LAA 2017 CAVI

CT Mitral Scan region: Pre: lung apices to bottom of rib cage Left arm position *clinical trials: scan with left arm raised *cath lab: left arm down Slice thickness ≤ 1. 25 mm “Scan like a TAVR, just cut the legs off”

Goals Discuss pre-procedural Mitral CT protocol Identify utility of CT in pre-procedure screening Identify role of CT intra-procedural

Utility of CT pre-procedure Majority of mitral clinical trials require it Coronary evaluation Anatomical assessment

For your patients https: //leadershipfreak. blog/2011/05/15/gathering-options-without-creating-obligations/

How many options will there be https: //leadershipfreak. blog/2011/05/15/gathering-options-without-creating-obligations/

Utility of CT in pre-procedure mitral repair Majority of mitral clinical trials require it Coronary evaluation Anatomical assessment

Tradition Co-pay Sedation Groin hematoma … priceless Duplicate contrast exposure

1. Coronary evaluation from mitral CT

2. MR Etiology: flail anterior leaflet tip

MR Etiology and Repair risks

Coaptation line: NTR vs XTR

3. EF Quantification

4. LA LV 3 D Quantification LA size

Severe MR redefined with 3 D LA size

Goals Discuss pre-procedural Mitral CT protocol Identify utility of CT in pre-procedure screening Identify role of CT intra-procedural

Trans-septal: mid-posterior stick marked “x”

Fossa ovalis crossing Mitral ring

Summary Most mitral annulus and chordal technology trials pre-procedural CT CT dataset information underutilized Scalability, reproducibility available within CT

Thank you dwang 2@hfhs. org @deedeewangmd