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Purpose of Review: Recent advancements in transcatheter valvular interventions have resulted in a growing demand for advanced cardiac imaging to help guide these procedures., Recent Findings: Both echocardiography and multi-detector computed tomography have played essential roles in the maturation of transcatheter aortic valve replacement and are now building on these experiences and helping inform the nascent field of transcatheter mitral interventions. Advanced imaging is essential to aid in the diagnosis and determination of the mechanism of mitral regurgitation. In addition, they are integral to annular sizing, determination of the suitability of patient anatomy for specific devices and increasingly important in the determination of the risk of left ventricular outflow tract obstruction and providing appropriate patient-specific fluoroscopic angulation in advance of the procedure.

Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi CT ), reclassified prosthesis-patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi TTE )., Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi CT of the left ventricular outflow tract improves risk stratification., Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm 2 /m 2 ), moderate (≥0.65 and ≤0.85 cm 2 /m 2 ), or severe (≤0.65 cm 2 /m 2 ). Correlation of EOAi CT and EOAi TTE to 1-year outcomes was performed., Results: The incidence of PPM was 24% with EOA CT compared with 45% with EOAi TTE . Only 6% of PPM was graded severe by EOAi CT compared with 9% by EOAi TTE . EOAi TTE , but not EOAi CT , defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOA CT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi TTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome., Conclusions: EOAi CT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi TTE , but not EOAi CT , was associated with less left ventricular mass regression., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Auckland City Hospital (ACH) established a Heart Murmur Clinic (HMC) with the aim of providing prompt assessment of patients with asymptomatic systolic murmurs. This may lead to early intervention and improved outcomes if significant structural heart disease is detected and reassurance if no significant findings are found. Similar clinics for children have proven beneficial; the benefit of a HMC in an adult population has been difficult to determine., Aim: To review the clinical demographics and echocardiographic information of patients presenting to our HMC, to assess what proportion of significance structural heart disease had and determine the common structural abnormalities in this population., Methods: This is a retrospective review of patients aged ≥15 years presenting to our HMC between March 2010 and December 2015 with an asymptomatic systolic murmur. Patients with previous cardiac surgery or known congenital or valvular heart disease were excluded., Results: A total of 1221 patients was reviewed over the 5-year period; 980 underwent echocardiography. Significant cardiac disease was detected in 156 patients, with 23 patients requiring surgical intervention over the 5-year period. Significant aortic stenosis (n = 43) and mitral regurgitation (n = 48) were the most common pathologies. Patients > 65 years were more likely to have structural heart disease (16% vs 11%, P < 0.05)., Conclusion: Establishing a HMC has allowed the screening of a large number of patients who would otherwise have low priority for assessment. We have identified a large proportion with significant structural disease, which has allowed for early surgical intervention when appropriate and may potentially result in improved patient outcomes., (© 2016 Royal Australasian College of Physicians.)

Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Background: Motion correction (MC) algorithms have been shown to improve image quality, interpretability and diagnostic accuracy in coronary CT angiography. We sought to determine whether MC extended to the whole heart would demonstrate improved image quality and reproducibility of aortic annular measurements in pre-TAVR CT., Materials and Methods: Twenty-two consecutive contrast enhanced CT data sets acquired for pre TAVR evaluation using retrospective ECG synchronization during a single heart beat were retrospectively identified. Image data sets were obtained from raw data acquired at 35% and 75% of the R-R interval using both standard (STD) and motion corrected (MC) reconstruction algorithms. Four data sets (2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers for aortic annular area, short and long axis, perimeter and average diameter. Image quality was graded using a 5 point Likert score (1 and 2 non diagnostic, 5 excellent). Statistical analysis was performed using Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75% MC., Results: Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%, there was a significant improvement in image quality for MC (Likert score 3.3 ± 0.9 STD vs. 3.9 ± 0.7 MC, p < 0.007). While B-A analysis demonstrated narrower interobserver agreement for aortic annular area (bias 0.03 vs 0.02 cm(2), range -0.32 to 0.39 cm(2) vs -0.50 to 0.55 cm(2)), and perimeter (bias 0.3 vs 0.3 mm, range -3.1 to 3.8 mm vs -4.6 to 5.3 mm), this was not statistically significant by concordance correlation coefficient. At 75%, there was no significant difference in image quality (Likert score 3.3 ± 0.9 vs. 3.5 ± 0.76, p = 0.454) or annular measurement agreement intervals., Conclusion: Motion correction algorithms may yield significant improvements of image quality in systolic CT data sets of the heart. Further validation studies are required to determine the effect on annular measurements and translation into clinical practice., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)