CMR for Assessment of Valvular Disease

Surgical treatment of valvular heart disease (VHD) has the potential to revolutionize the lives of affected patients. Unfortunately, surgery carries the peri-operative risks of stroke, myocardial infarction and occasionally death. Longer term risks include anticoagulation for mechanical valves and the need for re-operation particularly in patients receiving bio-prosthetic valves. In patients presenting or being followed with VHD, decisions need to be made regarding appropriate medical therapy and when this should give way to surgical management. In addition to clinical factors, these decisions are dependent on the type and severity of the lesion, the presence of cardiac decompensation, and also in part on the type of operation required. Cardiac magnetic resonance (CMR) is able to provide accurate quantitative and qualitative data to inform this decision-making process. We review typical applications of CMR in the assessment of VHD, focusing on common indications, case reviews and current limitations, and concluding with exciting new applications in the area of valve mapping.