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Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition
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Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 2104

Special Issue Editors

Dr. Valeria Cammalleri

E-Mail Website
Guest Editor
Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
Interests: heart valve disease; tricuspid valve; mitral valve; echocardiography; computed tomography; structural heart disease interventions; multimodality imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Annalisa Pasquini

E-Mail Website
Guest Editor
Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, 20123 Rome, Italy
Interests: 3D echocardiography; transesophageal echocardiography; mitral regurgitation; aortic regurgitation; valvulopaties; heart failure

Special Issue Information

Dear Colleagues,

We invite you to participate in this Special Issue of JCM entitled “Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition”.

In recent years, several new therapeutic options have been proposed for the treatment of mitral and tricuspid valve disease, including minimally invasive cardiac surgery and structural interventional cardiology. At the same time, new echocardiographic techniques, computed tomography and magnetic resonance imaging have made significant advances in the diagnosis of valvular heart disease. Nevertheless, it remains a challenge to detect valvular heart disease early, to choose the right and timely intervention, and finally to find an appropriate imaging protocol for each approach in order to determine anatomical feasibility and predict the success of the intervention. With this in mind, rigorous patient selection, access to advanced surgical techniques, availability of safe and effective transcatheter devices and a careful research approach are critical to align these developments with the unmet clinical needs of patients.

The current Special Issue aims to provide the readers with an updated overview of the latest discoveries and new findings, analysis of previously published data, and new opinions and perspectives on imaging techniques for mitral and tricuspid valve disease.

Dr. Valeria Cammalleri
Dr. Annalisa Pasquini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • imaging in valvular heart disease
  • mitral valve disease
  • tricuspid valve disease
  • computed tomography
  • echocardiography
  • transesophageal echocardiography
  • cardiac magnetic resonance imaging
  • cardiac surgery
  • structural interventional cardiology
  • multi-modality imaging

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Published Papers (4 papers)

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Research

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11 pages, 7790 KiB  
Article
Three-Dimensional Modelling of Indexed Papillary Muscle Displacement in Patients Requiring Mitral Valve Surgery Using Four-Dimensional Echocardiography Variables
by Zhi Xian Ong, Ashlynn Ai Li Ler, Liang Shen, Theo Kofidis, Lian-Kah Ti and Faizus Sazzad
J. Clin. Med. 2024, 13(24), 7503; https://doi.org/10.3390/jcm13247503 - 10 Dec 2024
Viewed by 804
Abstract
Background: Two-dimensional and three-dimensional echocardiographic imaging are commonly used in assessing ischemic mitral regurgitation (IMR) and degenerative mitral regurgitation (DMR) in patients with mitral valve disease. However, the use of 4D echocardiographic imaging has not yet been reported. The objectives of this [...] Read more.
Background: Two-dimensional and three-dimensional echocardiographic imaging are commonly used in assessing ischemic mitral regurgitation (IMR) and degenerative mitral regurgitation (DMR) in patients with mitral valve disease. However, the use of 4D echocardiographic imaging has not yet been reported. The objectives of this study were to explore the efficacy of utilizing 4D echocardiographic variables, determine papillary muscle displacement in patients with either IMR or DMR, and compare the differences in papillary muscle displacement between groups. Methods: Thirty-four patients were divided into two groups: Group 1 (with IMR) and Group 2 (with DMR). Using clinical ultrasound software, 4D echocardiographic variables were obtained and compared between the groups. Pearson’s product–moment correlation test was used to assess the relationship between the presence of IMR and both papillary muscle displacement and indexed papillary muscle displacement. Results: The mean values for papillary muscle displacement in Groups 1 and 2 were 38 ± 6.7 mm and 31.8 ± 6.1 mm, respectively. Indexed papillary muscle displacement was 22.8 ± 3.7 mm in Group 1 and 18.4 ± 3.5 mm in Group 2. There were statistically significant correlations between the presence of IMR and papillary muscle displacement (p = 0.009) and indexed papillary muscle displacement (p = 0.002). A significant correlation was also observed between IMR and PL (p = 0.001), with mean values of 15.7 ± 3.9 mm in Group 1 and 20.2 ± 5.6 mm in Group 2. Conclusions: Four-dimensional echocardiography is effective in evaluating morphological variations in IMR. It successfully determined papillary muscle displacement in patients undergoing mitral valve surgery and demonstrated a positive correlation between IMR and indexed papillary muscle displacement. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition)
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Review

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25 pages, 7531 KiB  
Review
Isolated Tricuspid Regurgitation: When Is Surgery Appropriate? A State-of-the-Art Narrative Review
by Raffaele Barbato, Francesco Loreni, Chiara Ferrisi, Ciro Mastroianni, Riccardo D’Ascoli, Antonio Nenna, Marcello Bergonzini, Mohamad Jawabra, Alessandro Strumia, Massimiliano Carassiti, Felice Agrò, Massimo Chello and Mario Lusini
J. Clin. Med. 2025, 14(14), 5063; https://doi.org/10.3390/jcm14145063 - 17 Jul 2025
Viewed by 160
Abstract
The increasing interest in tricuspid regurgitation (TR) is due to the deep link between mortality and the severity of TR, as well as the limited application of surgical solutions in a setting marked by high in-hospital mortality, attributed to the late presentation of [...] Read more.
The increasing interest in tricuspid regurgitation (TR) is due to the deep link between mortality and the severity of TR, as well as the limited application of surgical solutions in a setting marked by high in-hospital mortality, attributed to the late presentation of the disease. This delay in intervention is likely associated with a limited understanding of valvular and ventricular anatomy as well as the pathophysiology of the disease, leading to an underestimation of TR severity. With the rapid development of transcatheter solutions showing early safety and efficacy, there is a growing necessity to accurately understand and diagnose the valvular disease process to determine suitable management strategies. This review will outline the normal and pathological anatomy of the tricuspid valve, classify the anatomical substrates of TR, and present new risk stratification methods to determine the appropriate timing for both medical and surgical treatment. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition)
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20 pages, 3356 KiB  
Review
Tricuspid Regurgitation in the Era of Transcatheter Interventions: The Pivotal Role of Multimodality Imaging
by Valeria Maria De Luca, Stefano Censi, Rita Conti, Roberto Nerla, Sara Bombace, Tobias Friedrich Ruf, Ralph Stephan von Bardeleben, Philipp Lurz, Fausto Castriota and Angelo Squeri
J. Clin. Med. 2025, 14(14), 5011; https://doi.org/10.3390/jcm14145011 - 15 Jul 2025
Viewed by 220
Abstract
Over the last ten years, transcatheter tricuspid valve interventions (TTVIs) have emerged as effective options for symptomatic patients with moderate-to-severe tricuspid regurgitation (TR) who are at prohibitive surgical risk. Successful application of these therapies depends on a patient-tailored, multimodal imaging workflow. Transthoracic and [...] Read more.
Over the last ten years, transcatheter tricuspid valve interventions (TTVIs) have emerged as effective options for symptomatic patients with moderate-to-severe tricuspid regurgitation (TR) who are at prohibitive surgical risk. Successful application of these therapies depends on a patient-tailored, multimodal imaging workflow. Transthoracic and transesophageal echocardiography remain the first-line diagnostic tools, rapidly stratifying TR severity, mechanism, and right ventricular function, and identifying cases requiring further evaluation. Cardiac computed tomography (CT) then provides anatomical detail—quantifying tricuspid annular dimension, leaflet tethering, coronary artery course, and venous access anatomy—to refine candidacy and simulate optimal device sizing and implantation angles. In patients with suboptimal echocardiographic windows or equivocal functional data, cardiovascular magnetic resonance (CMR) offers gold-standard quantification of RV volumes, ejection fraction, regurgitant volume, and tissue characterization to detect fibrosis. Integration of echo-derived parameters, CT anatomical notes, and CMR functional assessment enables the heart team to better select patients, plan procedures, and determine the optimal timing, thereby maximizing procedural success and minimizing complications. This review describes the current strengths, limitations, and future directions of multimodality imaging in comprehensive evaluations of TTVI candidates. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition)
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Other

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13 pages, 6290 KiB  
Case Report
Does Preliminary Chest Shape Assessment Improve the Prognostic Risk Stratification of Individuals with Mitral Annular Disjunction? A Case Report and Narrative Review
by Andrea Sonaglioni, Gian Luigi Nicolosi, Giovanna Elsa Ute Muti-Schünemann, Gaetana Anna Rispoli, Michele Lombardo and Paola Muti
J. Clin. Med. 2025, 14(7), 2277; https://doi.org/10.3390/jcm14072277 - 26 Mar 2025
Viewed by 433
Abstract
Background: Mitral annular disjunction (MAD), a mitral annular abnormality involving the whole mitral valve annulus circumference, commonly detected in individuals with mitral valve prolapse (MVP), has been recently recognized as a potential risk factor for malignant ventricular arrhythmias (VAs) and sudden cardiac death. [...] Read more.
Background: Mitral annular disjunction (MAD), a mitral annular abnormality involving the whole mitral valve annulus circumference, commonly detected in individuals with mitral valve prolapse (MVP), has been recently recognized as a potential risk factor for malignant ventricular arrhythmias (VAs) and sudden cardiac death. Recent evidence indicates that a multimodality imaging assessment comprehensive of echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography angiography (CCTA) may improve MAD detection. To date, no previous author has considered the potential influence of chest wall conformation on MAD presence. Considering the strong association between MVP and anterior chest wall deformities and the increased prevalence of MAD among MVP individuals, we have hypothesized that MAD presence might be more frequently detected among MVP individuals with a narrow anteroposterior (A-P) thoracic diameter and/or concave-shaped chest wall conformation, as noninvasively assessed by the modified Haller index (MHI). Methods: Herein, we present a case of MVP female with relevant MAD distance and moderate mitral regurgitation (MR) who underwent a diagnostic study comprehensive of transthoracic echocardiography, transesophageal echocardiography, CMR, CCTA, and exercise stress echocardiography. Results: The patient was found with a concave-shaped chest wall conformation (MHI > 2.5) and narrow A-P thoracic diameter (<13.5 cm), with a moderate and non-hemodynamically significant MR, without areas of LGE on CMR and with low arrhythmic profile. Conclusions: A preliminary chest shape assessment by the MHI might improve the prognostic risk stratification of MVP patients with MAD, potentially identifying a benign phenotype of MVP individuals, i.e., those with a narrow A-P thoracic diameter. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition)
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