The development of non-surgical methods for the treatment of heart valve disease in children as well as in adults has recently become a reality. The increased use of these methods would improve patient comfort, avoid prolonged hospital care and stay, and enable patients to return to normal daily activities in a shorter time, ultimately reducing healthcare costs. We currently have the largest worldwide experience of implanting percutaneous valves into the pulmonary position, and have safely performed over 200 cases. Magnetic resonance (MR) imaging has played a crucial role in the success of this programme by accurately defining the anatomy of the implantation site for improved patient selection and by demonstrating the technical and physiological success of the treatment. However, at present only a limited number of patients can benefit from this procedure due to variations in individual patient anatomy and loading conditions. The aim of this application is to use the past experience gained with MR imaging in the pulmonary position, along with similar and new methodologies, to enable device implantation in all patients' right and left ventricular outflow tracts. This will be achieved by using patient imaging data to systematically categorise implantation site morphology and dynamics and to develop models that will accurately predict modes of device failure. The imaging modality that can be best used to carry out these assessments and is most suited to aid device design will be established. Furthermore, imaging methods that will assist in the deployment of devices into complex cardiac morphologies will be developed. Overall these approaches will help us fully understand the implantation site, improve patient selection for safe device deployment, and create new methodologies to aid future device design, which may ultimately result in less animal testing and faster and cheaper development times.
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