Clinical Update in Cardiac Imaging Including Echocardiography

Volumetric determinations by cardiac magnetic resonance imaging after tetralogy of Fallot repair may more accurately assess significant right ventricular dilation and pulmonary regurgitation to guide timing of pulmonary valve replacement. Recent guidelines by the American and European Societies of Echocardiography have summarized the clinical approach to valvular stenosis. They emphasize aortic stenosis given its high incidence and assessment confounders such as left ventricular function, aortic regurgitation, systemic hypertension, and mitral regurgitation. The applications of 3-dimensional echocardiography have reached transcatheter procedures such as atrial septal closure, mitral valve repair, and aortic valve replacement. It also provides detailed assessment of the mitral valve, cardiac chambers, and can guide pediatric aortic valve repair. The timing of surgery in mitral regurgitation remains controversial, especially when it is asymptomatic with normal left ventricular function. Recent data emphasize the outcome advantage of mitral valve repair in asymptomatic mitral regurgitation when the effective regurgitant orifice area is >40 mm2. Transesophageal echocardiography is an established gold standard in the assessment of endocarditis. Multislice computed tomographic imaging has facilitated simultaneous detailed assessment of the cardiac valves and coronary arteries. Recent comparison has shown that these 2 imaging modalities are equivalent and complementary. Tricuspid valve regurgitation associated with mitral disease is common and important. At the time of mitral surgery, moderate or greater tricuspid regurgitation should be corrected, preferably by rigid annuloplasty. Recent evidence also supports tricuspid annuloplasty for an annular diameter >35 mm regardless of regurgitation severity. Although repair is preferred, tricuspid replacement also has acceptable outcomes.