Comparison of segmental mitral leaflet length assessment by TEE and cardiac CT in patients undergoing transcatheter mitral valve evaluation
T Zuhair Kassem, S Smolka, S Jung, F Ciotola, M Troebs, M Moshage, S Achenbach, M MarwanAbstract
Objective
Accurate assessment of mitral valve leaflet morphology is essential for patient selection and procedural planning in transcatheter mitral valve interventions. While transoesophageal echocardiography (TEE) and cardiac computed tomography (CT) are routinely performed prior to transcatheter mitral valve replacement, TEE remains the primary imaging modality for screening patients considered for transcatheter mitral edge-to-edge repair (TEER). As adequate leaflet length is critical for procedural success, potential systematic discrepancies between imaging modalities warrant further investigation.
Methods
Patients referred for comprehensive imaging prior to transcatheter mitral valve replacement using the Tendyne™ valve were screened for inclusion. All patients underwent both TEE and full-cycle cardiac CT as part of the standardized Tendyne™ screening protocol. The anterior (AML) and posterior (PML) mitral leaflets were measured in predefined anatomical segments (A1–A3, P1–P3). Corresponding segmental measurements obtained by TEE and CT were compared using paired t-tests. For each segment, mean differences (bias), standard deviations, and 95% confidence intervals (CI) were calculated to assess inter-modality agreement.
Results
Thirty patients (16 women; mean age 75y) were analyzed. Mean PML lengths in segments P1, P2, and P3 were 11 mm, 13 mm, and 11 mm by TEE versus 12 mm, 13 mm, and 12 mm by CT. Mean AML lengths in segments A1, A2, and A3 were 24 mm, 27 mm, and 23 mm by TEE versus 25 mm, 28 mm, and 24 mm by CT (p < 0.05). Across all segments, leaflet lengths measured by TEE were consistently shorter than those derived from CT. The overall bias was 0.9 mm for AML and 0.6 mm for PML (TEE < CT; p < 0.05). Statistically significant differences were observed in four segments (A1, A2, P1, and P3; p < 0.05 for each).
Conclusions
Although segmental mitral leaflet measurements obtained by TEE and CT demonstrate strong correlation, TEE systematically underestimates leaflet length compared with CT. These findings may be clinically relevant in borderline cases where leaflet length is critical for TEER planning and patient eligibility assessment. CT may provide complementary anatomical information to support procedural decision-making.