Images courtesy of Stanford 3D and Quantitative Imaging (3DQ) Laboratory.
Left image: Volume rendered image of the heart with myocardium denoted in red. A portion of the left ventricle has been remove to expose the mitral annular calcifications depicted in yellow.
Right image: Volume rendered imaging demonstrating the 3-D anatomy of the mitral annular ring, allowing for accurate device sizing.
Doctor Stories
Revolutionizing heart care with 3DQ imaging for TMVR
04.25.2025
Transcatheter mitral valve replacement (TMVR), a minimally invasive surgery to replace a damaged mitral valve, can help patients with severe mitral valve issues without the need for open-heart surgery. Stanford Medicine surgeons use advanced imaging from the Stanford 3D and Quantitative Imaging Laboratory (3DQ Lab) to personalize a TMVR procedure to their patient’s needs.
John W. MacArthur, MD
Cardiothoracic surgeon John W. MacArthur, MD, assistant professor of cardiothoracic surgery, and interventional cardiologist Rahul P. Sharma, MBBS, FRACP, clinical associate professor of cardiovascular medicine and director of Structural Interventions at Stanford Health Care, collaborated with 3DQ Lab on a patient evaluation. The patient had symptoms of fatigue, shortness of breath, and palpitations. 3D imaging showed the patient had a severely calcified mitral valve, which commonly causes mitral regurgitation.
Rahul P. Sharma, MBBS, FRACP
“3DQ Lab’s imaging gave us the additional data we needed to accurately diagnose our patient’s condition,” said Dr. MacArthur. “From there, we continued to partner with the lab to figure out the next care steps.”
To determine whether the patient was a good candidate for TMVR, a 3DQ Lab technologist performed a cardiac-gated CT angiogram of the patient’s abdomen, chest, and pelvis with contrast to observe blood flow. The cardiac gating synchronized images with specific phases of the patient’s cardiac cycle.
For instance, the 4D view of the patient’s mitral valve gave physicians a comprehensive view of the valve in motion, helping them see its structure and function. A 4D video also showed the valve’s opening and closing movements throughout the cycle, allowing physicians to detect calcium buildup and other irregularities, such as regurgitation.
“Due to the patient’s extensive heart calcifications, 3DQ Lab provided imaging and measurements for two different valve devices, the Intrepid valve and the SAPIEN valve,” said Dr. Sharma. “These measurements helped our team determine the best type and size valve for our patient, based on their anatomical requirements.”
Additionally, the lab provided a view of the patient’s venous delivery pathway to help determine the catheter’s path during the TMVR procedure. Measurements also showed different valve positioning scenarios that helped the team predict what placement might result in the best functioning post-procedure.
Brian Patrick Pogatchnik, MD
Stanford Medicine radiologists supervise the lab work at 3DQ Lab to ensure the highest quality imaging support for interventional procedures and help translate imaging data into actionable insights. In particular, Brian Patrick Pogatchnik, MD, clinical assistant professor of radiology, helped build up the lab’s ability to provide TMVR services and oversees workflow for these procedures.
The collaboration with 3DQ Lab runs across departments and specialties, including cardiothoracic surgery, cardiovascular medicine, interventional cardiology, radiology, and cardiovascular imaging. This teamwork provides a comprehensive approach to moving patient care forward through expertise and innovation.
See the case study from Stanford Medicine.
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