Neo-LVOT and Transcatheter Mitral Valve Replacement: Expert Recommendations

JACC Cardiovasc Imaging. 2021 Apr;14(4):854-866. doi: 10.1016/j.jcmg.2020.09.027. Epub 2020 Nov 25.

Abstract

With the advent of transcatheter mitral valve replacement (TMVR), the concept of the neo-left ventricular outflow tract (LVOT) was introduced and remains an essential component of treatment planning. This paper describes the LVOT anatomy and provides a step-by-step computed tomography methodology to segment and measure the neo-LVOT while discussing the current evidence and outstanding challenges. It also discusses the technical and hemodynamic factors that play a major role in assessing the neo-LVOT. A summary of expert-based recommendations about the overall risk of LVOT obstruction in different scenarios is presented along with the currently available methods to reduce the risk of LVOT obstruction and other post-procedural complications.

Keywords: LVOT; LVOT obstruction; neo-LVOT; transcatheter mitral valve replacement.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization / adverse effects
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis*
  • Humans
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Predictive Value of Tests
  • Ventricular Outflow Obstruction*