Clinical trials of transcatheter mitral valve and tricuspid valve repair and replacement devices have begun in earnest, with the ultimate goal of providing definitive, nonsurgical treatment for the millions of patients with severe, symptomatic regurgitation, many of whom are too high risk or inoperable for a surgical approach. Computed tomography (CT) angiography offers the potential for detailed anatomic assessment in this patient population, but its optimal implementation for patients with mitral and tricuspid disease requires patient-centered protocol specification reflecting the goal of the scan, an understanding of complex anatomy and pathophysiology, and particulars of CT scanner capabilities. In this paper, the need for new interventional approaches to mitral and tricuspid valve disease is discussed, followed by a detailed review of how to perform a high-quality CT angiography examination, taking into consideration scanner- and patient-specific variables when preparing a pre-mitral or tricuspid protocol. The many possible clinical challenges affecting the performance of cardiac and vascular CT angiography for pre-procedure mitral and tricuspid repair/replacement are reviewed and specific tips, trouble-shooting approaches, and recommendations are provided for how to conduct the best-quality study, be it at an experienced imaging center with the most advanced scanner or at a novice center using an earlier generation CT platform.

中文翻译：

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优化心脏CT方案以进行经皮MV和TV修复/置换之前的全面采集

经导管二尖瓣和三尖瓣修复及置换装置的临床试验已开始认真进行，其最终目标是为数百万患有严重症状性反流的患者提供确定的非手术治疗，其中许多患者风险高或无法手术治疗。手术方法。计算机断层扫描（CT）血管造影技术可为该患者群体进行详细的解剖学评估，但对于二尖瓣和三尖瓣疾病患者的最佳实施，则需要以患者为中心的协议规范，以反映扫描的目标，对复杂解剖学和病理生理学的理解， CT扫描仪功能的详细信息。在本文中，讨论了对二尖瓣和三尖瓣疾病的新介入方法的需求，随后详细审查如何进行高质量的CT血管造影检查，并在准备二尖瓣或三尖瓣手术方案时考虑扫描仪和患者的特定变量。回顾了影响心脏和血管CT血管造影术前二尖瓣和三尖瓣修复/置换性能的许多可能的临床挑战，并就如何进行最佳质量的研究提供了具体技巧，疑难解答方法和建议。它可以在经验丰富的成像中心使用最先进的扫描仪，也可以在新手中心使用较早的CT平台进行处理。