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Feasibility of a new automatic imaging tool prototype for interventional mitral valve therapy
Arnaud Van Linden, Mani Arsalan, Claudia Walther, Won-Keun Kim, Christoph Liebetrau, Ulrich Fischer-Rasokat, Mirko Doss, Thomas Walther.
Kerckhoff Klinik, Bad Nauheim, Germany.

OBJECTIVE: Precise imaging is a prerequisite for interventional mitral valve procedures such as MitraClip or transcatheter mitral valve implantation. This includes evaluation of the left atrium (LA), the interatrial septum, the mitral valve, the left ventricle and the left ventricular outflow tract. Mitral Valve Guidance (MVG, Siemens Healthcare GmbH, Germany) is a new software prototype that allows for automatic segmentation of these relevant landmarks from multi slice computed tomography (MSCT) datasets. This is a preliminary feasibility study of first clinical experience using the MVG.
METHODS: MSCT scans of 10 patients were imported into the MVG workstation and processed automatically.
RESULTS: 3D reconstruction of the LA, followed by segmentation and landmark detection was automatically started by the MVG prototype (Figure). Pulmonary veins are colored in purple, the LA red, the LA appendage in dark blue and the mitral valve leaflets in green and light blue. The mitral valve annulus and the coaptation line are presented as yellow lines and a centerline is derived through the middle of the coaptation line. A virtual septum model for transseptal crossing is calculated and the distance between this virtual septum and the LA appendage can be measured. The automatic segmentation and landmark detection worked well in all MSCT datasets from 10 patients.
CONCLUSIONS: The Mitral ValveGuidance prototype offers a new tool for interventional mitral valve therapy planning. Automatic segmentation may lead to reproducible and examiner-independent results. Intraprocedural registration based on data acquisition using a DynaCT spin is possible and may lead to direct procedural guidance. Further and larger investigational studies are ongoing.

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