Functional assessment of bioprosthetic mitral valves by cardiovascular magnetic resonance: An in vitro validation and comparison to Doppler echocardiography

Dimitrios Maragiannis, Matthew S. Jackson, Kyle Autry, Jose H. Flores Arredondo, Constantina Aggeli, Dimitrios Tousoulis, William A. Zoghbi, Dipan J. Shah, Stephen H. Little

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: A comprehensive non-invasive evaluation of bioprosthetic mitral valve (BMV) function can be challenging. We describe a novel method to assess BMV effective orifice area (EOA) based on phase contrast (PC) cardiovascular magnetic resonance (CMR) data. We compare the performance of this new method to Doppler and in vitro reference standards.

METHODS: Four sizes of normal BMVs (27, 29, 31, 33 mm) and 4 stenotic BMVs (27 mm and 29 mm, with mild or severe leaflet obstruction) were evaluated using a CMR- compatible flow loop. BMVs were evaluated with PC-CMR and Doppler methods under flow conditions of; 70 mL, 90 mL and 110 mL/beat (n = 24). PC-EOA was calculated as PC-CMR flow volume divided by the PC- time velocity integral (TVI).

RESULTS: PC-CMR measurements of the diastolic peak velocity and TVI correlated strongly with Doppler values (r = 0.99, P < 0.001 and r = 0.99, P < 0.001, respectively). Across all conditions tested, the Doppler and PC-CMR measurement of EOA (1.4 ± 0.5 vs 1.5 ± 0.7 cm 2, respectively) correlated highly (r = 0.99, P < 0.001), with a minimum bias of 0.13 cm 2, and narrow limits of agreement (- 0.2 to 0.5 cm 2).

CONCLUSION: We describe a novel method to assess BMV function based on PC measures of transvalvular flow volume and velocity integration. PC-CMR methods can be used to accurately measure EOA for both normal and stenotic BMV's and may provide an important new parameter of BMV function when Doppler methods are unobtainable or unreliable.

Original languageEnglish (US)
Article number55
Pages (from-to)55
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
StatePublished - Jul 30 2020


  • Cardiovascular magnetic resonance; bioprosthetic valve
  • Doppler echocardiography
  • Mitral valve
  • Prosthetic valve stenosis
  • Predictive Value of Tests
  • Reproducibility of Results
  • Heart Valve Prosthesis
  • Humans
  • Mitral Valve/diagnostic imaging
  • Bioprosthesis
  • Echocardiography, Doppler, Color
  • Prosthesis Design
  • Feasibility Studies
  • Magnetic Resonance Imaging
  • Heart Valve Prosthesis Implantation/adverse effects
  • Blood Flow Velocity
  • Mitral Valve Stenosis/diagnostic imaging
  • Hemodynamics
  • Observer Variation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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