Computed tomography evaluation in valvular heart disease

Valvular heart disease (VHD) affects 2.5% of US adults and predominantly involves the left-sided cardiac structures. Regurgitant lesions are more common than stenoses, and mitral regurgitation (MR) is the most prevalent abnormality [1]. Doppler echocardiography is the initial imaging modality of choice, allowing for a complete diagnosis in the majority of patients [2]. In cases of poor acoustic window and/or disparate results regarding disease severity, additional tests may be required. Cardiac catheterization is a time-honored modality, but limited by its invasive nature. Magnetic resonance imaging (MRI) has become an excellent noninvasive alternative for both valvular insufficiency and stenosis [3]. Due to the need for radiation and contrast, computed tomography (CT) has a limited role for the evaluation of VHD as the primary indication. It may occasionally be employed as such when echocardiographic results are inconclusive and the patient is not a good candidate for MRI. However, CT is increasingly used for noninvasive coronary angiography, and useful information on valve anatomy and function can simultaneously be obtained from a coronary examination. Also, in patients with primary valve diseases, ruling out obstructive coronary artery disease is deemed a highly appropriate indication and may allow patients to forgo invasive coronary angiography.