Imaging
Mitral Regurgitation
- Preliminary Diagnosis: Mitral Regurgitation
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of mitral regurgitation.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mitral regurgitation.
- VI. What are the contraindications for the alternative imaging techniques?
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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