Anatomy of the Mitral Valvular Complex and its Implications for Transcatheter Interventions for Mitral Regurgitation

Mitral regurgitation (MR) poses a significant clinical burden in the adult population, which is expected to increase even more with the ever prolonging life expectancies in developed countries. New technology has brought MR, once exclusively the arena of cardiac surgeons, to the attention of interventional cardiologists. A variety of device-oriented transcatheter strategies have evolved in recent years. A comprehensive understanding of mitral valvular anatomy is crucial for the selection of patients, the implementation of devices, and further refinements of these transcatheter techniques if they are eventually to produce procedural and clinical success. The aim of this review is to elucidate the morphology of the mitral valvular complex, integrating key anatomical features into the developing transcatheter options for the treatment of MR.

PMID: 20705218

Detection of Coronary Artery Anomalies by Dual-Source CT Coronary Angiography

OBJECTIVES: To retrospectively evaluate the clinical value of dual-source computed tomography (DSCT) coronary angiography in the diagnosis of coronary artery anomalies.

METHODS: A large cohort of 3625 consecutive patients, who underwent DSCT coronary angiography in our institute, was reviewed for coronary artery anomalies. All images were evaluated by two experienced readers using axial source images, multi-planar reformations (MPR), maximum intensity projections (MIP) and volume rendering (VR). Coronary artery anomalies were found in 36 patients (male 20, female 16, mean age 48 years, range 15-76 years). Of the 36 patients, 19 patients also underwent conventional coronary angiography (CCA).

RESULTS: The incidence of coronary artery anomalies was 0.99% (36/3625). Six different types of coronary artery anomalies were diagnosed by DSCT coronary angiography: (1) 11 anomalies of the right coronary artery; (2) five anomalies of the left coronary artery; (3) 10 anomalies of the left circumflex artery; (4) two single coronary artery; (5) one anomalous pulmonary origin of the coronary artery; (6) seven coronary artery fistula. Evaluation of the CCA resulted in a precise diagnosis in 53% (10/19) patients.

CONCLUSION: DSCT coronary angiography is a good diagnostic tool to examine coronary artery anomalies.

PMID: 20797468

Assessment of Subendocardial Structure and Function

The combination of high energy expenditure and the borderline adequacy of perfusion make the subendocardium uniquely vulnerable to injury.  Selective subendocardial involvement is usually a marker of subclinical disease.

Technical advances in new noninvasive imaging modalities, especially in spatial resolution, now permit qualitative and quantitative assessment of subendocardial structure, function, and perfusion.  Many newer techniques have the potential to provide superior prognostic information to current standard assessment methods.  This review describes the contemporary capabilities of multiple imaging modalities for assessment of the subendocardium, and seeks to guide the clinician regarding the information and technical deficiencies of each modality.

PMID: 20705269