CT Planning for TMVR and Predicting LVOT Obstruction

Left ventricular outflow tract (LVOT) obstruction is a life-threatening complication of transcatheter mitral valve replacement (TMVR) therapies. Cardiac computed tomography (CT) analysis for TMVR planning is less well-understood by clinical teams, as TMVR technologies are evolving along with Mitral CT analysis algorithms for clinical teams. Retrospectively gated cardiac CT scans are required for in-depth TMVR case planning. Sizing and modeling for a transcatheter heart valve involve synthesis of device-specific interactions within each patient's anatomy encompassing concepts of landing zone sizing, device anchoring, subvalvular apparatus interference, and predicting risk of LVOT obstruction. Severe right ventricular volume overload and patients on hemodialysis will have different LVOT sizes depending on the amount of chamber volume at time of cardiac CT scan acquisition. Hence, CT evaluation of the LVOT requires integration of cardiac pathophysiology, echocardiography, and hemodynamics into accurate peri-procedural TMVR planning. Neo-LVOT prediction modeling by CT for TMVR planning involves planning for optimal and worst-case scenario TMVR implantation.