Imaging in Minimally Invasive Mitral Valve Repair

Minimally invasive mitral valve (MV) repair and replacement techniques have evolved as increasingly used alternatives to open heart surgery especially in patients unsuitable for surgery or at high perioperative risk. The vast majority of these techniques are still under development, and only a limited number of devices are approved for clinical use; however, they do show promising results in terms of minimizing complications and improving clinical outcome. The complex anatomy of the MV and the annulus complicates not only the development of devices for minimally invasive MV repair or replacement but also complicates preprocedural planning, which is mandatory for minimization of postprocedural complications. Although echocardiography still plays a crucial clinical role, cross-sectional imaging modalities such as coronary computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) are increasingly gaining importance for preprocedural planning. Specifically, CCT seems to be more practicable for preinterventional planning and device sizing, whereas CMR has been shown useful in detecting increased risk for adverse clinical outcomes through delayed gadolinium enhancement and the monitoring of cardiac morphology and function in the framework of follow-up examinations. This article describes recent techniques currently available or under development for minimally invasive repair or replacement of the MV and reviews the current state of CCT and CMR imaging for preinterventional and postinterventional diagnostic workup.