Published Online:https://doi.org/10.1148/rg.306105518

CT and MR imaging appearances of the normal and diseased mitral valve are reviewed, and abnormal imaging features are correlated with pathologicfindings in surgical specimens.

Computed tomography (CT) and magnetic resonance (MR) imaging are increasingly important adjuncts to echocardiography for the evaluation of mitral valve disease. The mitral valve may be involved in various acquired or congenital conditions with resultant regurgitation or stenosis, and many of these conditions can be identified with CT or MR imaging. In addition, CT is useful for detecting and monitoring postoperative complications after mitral valve repair or replacement. As the use of CT and MR imaging increases, awareness of the CT and MR imaging appearances of the normal mitral valve and the various disease processes that affect it may foster recognition of unsuspected mitral disease in patients undergoing imaging for other purposes. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.306105518/-/DC1

© RSNA, 2010

References

  • 1 Ho SY. Anatomy of the mitral valve. Heart 2002;88(suppl 4):iv5–iv10.
  • 2 Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006;368(9540):1005–1011.
  • 3 Chen JJ, Manning MA, Frazier AA, Jeudy J, White CS. CT angiography of the cardiac valves: normal, diseased, and postoperative appearances. RadioGraphics 2009;29(5):1393–1412.
  • 4 Glockner JF, Johnston DL, McGee KP. Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques. RadioGraphics 2003;23(1):e9.
  • 5 Feuchtner GM, Stolzmann P, Dichtl W, et al.. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol 2009;53(5):436–444.
  • 6 Didier D, Ratib O, Lerch R, Friedli B. Detection and quantification of valvular heart disease with dynamic cardiac MR imaging. RadioGraphics 2000;20(5):1279–1299;discussion 1299–1301.
  • 7 Oosthoek PW, Wenink AC, Wisse LJ, Gittenberger-de Groot AC. Development of the papillary muscles of the mitral valve: morphogenetic background of parachute-like asymmetric mitral valves and other mitral valve anomalies. J Thorac Cardiovasc Surg 1998;116(1):36–46.
  • 8 Perloff JK, Roberts WC. The mitral apparatus: functional anatomy of mitral regurgitation. Circulation 1972;46(2):227–239.
  • 9 Barlow JB. Perspectives on the mitral valve. Philadelphia, Pa: F.A. Davis, 1987.
  • 10 Fuster V. Hurst's the heart. 12th ed. New York, NY: McGraw-Hill Medical, 2008.
  • 11 Libby P, Braunwald E. Braunwald's heart disease: a textbook of cardiovascular medicine. 8th ed. Philadelphia, Pa: Saunders/Elsevier, 2008.
  • 12 Olson LJ, Subramanian R, Ackermann DM, Orszulak TA, Edwards WD. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc 1987;62(1):22–34.
  • 13 Schnyder PA, Sarraj AM, Duvoisin BE, Kapenberger L, Landry MJ. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe. AJR Am J Roentgenol 1993;161(1):33–36.
  • 14 Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet 2005;365(9458):507–518.
  • 15 Enriquez-Sarano M, Freeman WK, Tribouilloy CM, et al.. Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography. J Am Coll Cardiol 1999;34(4):1129–1136.
  • 16 Ling LH, Enriquez-Sarano M, Seward JB, et al.. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996;335(19):1417–1423.
  • 17 D'Ancona G, Mamone G, Marrone G, et al.. Is- chemic mitral valve regurgitation: the new challenge for magnetic resonance imaging. Eur J Cardiothorac Surg 2007;32(3):475–480.
  • 18 Sherrid MV, Gunsburg DZ, Moldenhauer S, Pearle G. Systolic anterior motion begins at low left ventricular outflow tract velocity in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2000;36(4):1344–1354.
  • 19 Maron MS, Olivotto I, Zenovich AG, et al.. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 2006;114(21):2232–2239.
  • 20 Mueller GC, Attili A. Cardiomyopathy: magnetic resonance imaging evaluation. Semin Roentgenol 2008;43(3):204–222.
  • 21 Zoghbi WA, Enriquez-Sarano M, Foster E, et al.. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16(7):777–802.
  • 22 Alkadhi H, Wildermuth S, Bettex DA, et al.. Mitral regurgitation: quantification with 16-detector row CT—initial experience. Radiology 2006;238(2):454–463.
  • 23 Guo YK, Yang ZG, Ning G, et al.. Isolated mitral regurgitation: quantitative assessment with 64-section multidetector CT—comparison with MR imaging and echocardiography. Radiology 2009;252(2):369–376.
  • 24 Gelfand EV, Hughes S, Hauser TH, et al.. Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson 2006;8(3):503–507.
  • 25 Kozerke S, Schwitter J, Pedersen EM, Boesiger P. Aortic and mitral regurgitation: quantification using moving slice velocity mapping. J Magn Reson Imaging 2001;14(2):106–112.
  • 26 Bonow RO, Carabello BA, Chatterjee K, et al.. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52(13):e1–e142.
  • 27 Oh JK, Seward JB, Tajik AJ. The echo manual. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2006; 202.
  • 28 Apter S, Shemesh J, Raanani P, et al.. Cardiovascular calcifications after radiation therapy for Hodgkin lymphoma: computed tomography detection and clinical correlation. Coron Artery Dis 2006;17(2):145–151.
  • 29 Iyer R, Jhingran A. Radiation injury: imaging findings in the chest, abdomen and pelvis after therapeutic radiation. Cancer Imaging 2006;6:S131–S139.
  • 30 Muddassir SM, Pressman GS. Mitral annular calcification as a cause of mitral valve gradients. Int J Cardiol 2007;123(1):58–62.
  • 31 Syed IS, Feng D, Harris SR, et al.. MR imaging of cardiac masses. Magn Reson Imaging Clin N Am 2008;16(2):137–164, vii.
  • 32 Anavekar NS, Bonnichsen CR, Foley TA, et al.. CT of cardiac pseudotumors and neoplasms. Radiol Clin North Am (in press).
  • 33 Djavidani B, Debl K, Lenhart M, et al.. Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol 2005;45(12):2048–2053.
  • 34 Heidenreich PA, Steffens J, Fujita N, et al.. Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging. Am J Cardiol 1995;75(5):365–369.
  • 35 Messika-Zeitoun D, Serfaty JM, Laissy JP, et al.. Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography. J Am Coll Cardiol 2006;48(2):411–413.
  • 36 O'Brien KR, Cowan BR, Jain M, Stewart RA, Kerr AJ, Young AA. MRI phase contrast velocity and flow errors in turbulent stenotic jets. J Magn Reson Imaging 2008;28(1):210–218.
  • 37 Cannan CR, Nishimura RA, Reeder GS, et al.. Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J Am Coll Cardiol 1997;29(1):175–180.
  • 38 Kohsaka S, Jin Z, Rundek T, et al.. Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study. JACC Cardiovasc Imaging 2008;1(5):617–623.
  • 39 D'Cruz I, Panetta F, Cohen H, Glick G. Submitral calcification or sclerosis in elderly patients: M mode and two dimensional echocardiography in “mitral anulus calcification”. Am J Cardiol 1979;44(1):31–38.
  • 40 Kronzon I, Winer HE, Cohen ML. Sterile, caseous mitral anular abscess. J Am Coll Cardiol 1983;2(1):186–190.
  • 41 Izgi C, Cevik C, Basbayraktar F. Caseous calcification and liquefaction of the mitral annulus: a diagnostic confounder. Int J Cardiovasc Imaging 2006;22(3-4):543–545.
  • 42 Monti L, Renifilo E, Profili M, Balzarini L. Cardiovascular magnetic resonance features of caseous calcification of the mitral annulus. J Cardiovasc Magn Reson 2008;10(1):25.
  • 43 Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994;96(3):200–209.
  • 44 Opotowsky AR, Siddiqi OK, Webb GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol 2009;54(5):460–467.
  • 45 Craig B. Atrioventricular septal defect: from fetus to adult. Heart 2006;92(12):1879–1885.
  • 46 Shone JD, Sellers RD, Anderson RC, Adams P, Lillehei CW, Edwards JE. The developmental complex of “parachute mitral valve,” supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Am J Cardiol 1963;11:714–725.
  • 47 Baño-Rodrigo A, Van Praagh S, Trowitzsch E, Van Praagh R. Double-orifice mitral valve: a study of 27 postmortem cases with developmental, diagnostic and surgical considerations. Am J Cardiol 1988;61(1):152–160.
  • 48 Suri RM, Schaff HV, Dearani JA, et al.. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. J Thorac Cardiovasc Surg 2009;137(5):1071–1076.
  • 49 Suri RM, Schaff HV, Dearani JA, et al.. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82(3):819–826.
  • 50 Suri RM, Grewal J, Mankad S, Enriquez-Sarano M, Miller FA, Schaff HV. Is the anterior intertrigonal distance increased in patients with mitral regurgitation due to leaflet prolapse? Ann Thorac Surg 2009;88(4):1202–1208.
  • 51 David TE, Burns RJ, Bacchus CM, Druck MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 1984;88(5 pt 1):718–725.
  • 52 Willerson JT. Cardiovascular medicine. 3rd ed. London, England: Springer, 2007.
  • 53 Leborgne L, Renard C, Tribouilloy C. Usefulness of ECG-gated multi-detector computed tomography for the diagnosis of mechanical prosthetic valve dysfunction. Eur Heart J 2006;27(21):2537.

Article History

Received: Feb 16 2010
Revision requested: Mar 12 2010
Revision received: Apr 1 2010
Accepted: Apr 15 2010
Published online: Oct 6 2010
Published in print: Oct 2010