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Cardiovascular Magnetic Resonance for Valvular Heart Disease

Session 621

Valvular heart disease remains an important health problem. In Western countries, the increasing age of the population leads to an increasing number of patients with degenerative valve disease (particularly aortic stenosis and mitral regurgitation), while in developing countries, rheumatic valve disease remains the leading cause.

Echocardiography is the mainstay imaging technique to evaluate patients with valvular heart disease. The complementary role of cardiac magnetic resonance (CMR) in the evaluation of valvular heart disease was underscored in this session. In patients with challenging acoustic windows and inconsistently graded severity of valvular heart disease, CMR provides high spatial resolution data to characterize the valve anatomy (i.e. to differentiate between bicuspid and tricuspid aortic valve), quantify cardiac chamber dimensions and function, and to assess the dimensions of the aorta. In terms of evaluation of valve hemodynamics, CMR has been shown accurate to quantify the severity of valvular dysfunction, although it has a lower temporal resolution compared to echocardiography,.

Dr. Le Ven presented interesting data on the assessment of the anatomy and effective orifice area quantification in stenotic and regurgitant valve lesions. In addition, Dr Le Ven underscored the growing interest in the effects of the valvular lesion on left ventricular mechanics, beyond the simple measurement of left ventricular ejection fraction. With the use of late gadolinium enhancement, replacement and diffuse myocardial fibrosis can be assessed with CMR. The presence of replacement fibrosis has been associated with prognosis and clinical outcomes after surgical treatment of valve disease (i.e. symptom relief, left ventricular functional recovery). However, the clinical implications of the assessment of diffuse fibrosis remain under investigation and further studies are needed. Advances in post-processing software and standardization of data acquisition will help to implement this technique in clinical practice.

Dr.Kilner provided new insights into the pathophysiology of mitral valve prolapse, highlighting specific phenotypes of the left ventricle and mitral annulus dynamics that can be assessed with cine CMR. Dr. Alpendurada provided a comprehensive overview of the role of CMR to evaluate patients with bicuspid aortic valves , with particular focus on associated aortopathy and life-threatening complications such as aortic dissection.

Finally, as a glimpse into the near future, Dr. Ebbers summarized the technical aspects of 4D flow assessment with CMR. 4D flow assessment is the most frequently used method to visualize (streamlines, pathlines and vectors) and to quantify (peak velocities and flow volume) blood flow through the valves. Whether this imaging application is ready for use in clinical practice, and whether it has consequences for the management of patients with valvular heart disease remains to be demonstrated.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.