PMC9883726_01
Pre-procedural computed tomography scan assessment of mitral valve. (A) Important calcification of mitral annulus and posterior mitral leaflet visible in two cavities view. (B) Large and redundant anterior mitral leaflet in left ventricular outflow tract view. (C) Computed tomography scan reconstruction of predictive neo-left ventricular outflow tract with Sapien 3, 29 mm prosthesis.
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A preliminary feasibility assessment was carried out and included a cardiac computed tomography (CT) scan (Figure 1). The calcifications required for prosthesis anchoring, and in particular, the large and continuous calcifications of the posterior leaflet were clearly visible on the CT scan (Figure 1A) and were associated with a long and redundant anterior mitral leaflet (Figure 1B). The mitro-aortic angle measured 117.3  and the neo-LVOT area measurement (3mensio software) was 175.4 mm2 (Figure 1C).
Computed tomography scan of mitral prosthesis after dilatation of left ventricular outflow tract. (A) Two-dimensional mitral prosthesis with D-shape deformation. (B) Three-dimensional mitral prosthesis with D-shape deformation.
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A CT scan without contrast medium showed an obvious, D-shaped deformation of the Sapien 3 valve (Edwards Lifesciences) caused by the inflated balloon used to treat the obstruction (Figure 2A). This deformation was also visible on the 3D reconstruction of the CT scan images (Figure 2B).