Limitations
As with most imaging studies, our study is limited by inter-observer bias. Interestingly, our MDCT readers were less experienced than the TEE readers and still were able to generate similar measurements. Despite our high-quality scanner there was sometimes systolic artifact on MDCT which may reduce accuracy. Additionally, in cases where leaflet pathology involves more than one area, interpretation on MDCT may be limited. Since obtaining preoperative MDCT is not standard practice for DMR we had a limited number of patients included and the potential for selection bias of those included. Most commonly MDCT was obtained in patients with complex TEE anatomy to further assess the mitral valve apparatus. Lastly, the imaging was performed on different days and the hemodynamics may vary among TEE (done under sedation) and MDCT (performed with IV contrast volume load).