Imaging

Mitral Regurgitation

Preliminary Diagnosis: Mitral Regurgitation

I. What imaging technique is first-line for this diagnosis?

  • Echocardiography (transthoracic)

II. Describe the advantages and disadvantages of this technique for diagnosis of mitral regurgitation.

Advantages

  • Offers exquisite anatomical and functional imaging

  • Does not expose patients to ionizing radiation

  • Helps detect pressure gradients and velocities across a diseased valve and helps guide treatment

Disadvantages

  • Highly operator dependent

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications exist

IV. What alternative imaging techniques are available?

  • CTA

  • MR/MRA of the heart

  • PA and lateral view of the chest

  • Conventional cardiac catheter angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mitral regurgitation.

CTA

Advantages

  • Offers exquisite detail of the anatomical structures, including vascular, soft tissue, lymphatic, and osseous structures

  • Highly sensitive and specific to vascular calcification

Disadvantages

  • Exposes patients to ionizing radiation

  • Does not allow for therapeutic intervention

MR/MRA of the Heart

Advantages

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Must be cardiac gated

PA and lateral view of the chest

Advantages

  • Relatively inexpensive, portable imaging modality

Disadvantages

  • Moderately sensitive and poorly specific in detecting and diagnosing mitral regurgitation

  • Does not allow for adequate delineation of the surrounding anatomical structures

Conventional Cardiac Catheter Angiography

Advantages

Offers exquisite detail of the cardiac valvular architecture and helps detect any other coexisting abnormalities

Disadvantages

  • Exposes patients to greater morbidity and mortality secondary to the invasive nature of the exam

  • Exposes patients to larger amounts of ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

CTA

  • May be contraindicated in pregnant patients

MR/MRA of the heart

  • Contraindicated in patients with non–MR-compatible hardware

PA and lateral view of the chest

  • No specific contraindication to plain radiography. Some institutions may require consent for pregnant patients

Conventional cardiac catheter angiography

  • Contraindicated in patients who are in a severe hypocoagulable state

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