State-of-the-Art Review: Transjugular Tricuspid Valve Replacement Using the LuX-Valve Plus System

Figures

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  Figure 1. TTE and TEE evaluation of a patient with torrential TR related to a carcinoid disease. (a and b) Severe RV dilatation with diastolic septal shift of the interventricular septum. (c and d) Important tethering and restriction of the tricuspid leaflets and wide coaptation gap in 2D and 3D MPR. Significant thickening of the subvalvular apparatus was also observed in TTE (e) with torrential TR in color Doppler (f) Abbreviations: MPR, multiplanar reconstruction; RV, right ventricle; TEE, transesophageal echocardiography; TR, tricuspid regurgitation; TTE, transthoracic echocardiography.

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  Figure 2. Procedural room set-up and team positioning for transjugular tricuspid valve replacement procedures.

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  Figure 3. Computed tomography analysis for TTVR screening using the Lux-Valve Plus system – Part 1. (a) The annular area, perimeter, and maximum and minimum diameters are measured in diastole to determine the appropriate device size and percentage oversizing. (b) Dimensions of the fabric skirt plane are also measured. (c and d) The target positions of the device and septal anchor are modeled. (e) The distances between the center of the tricuspid annulus and the free wall of the right ventricle and the right ventricle are measured Abbreviation: TTVR, transcatheter tricuspid valve replacement.

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  Figure 4. Computed tomography analysis for TTVR screening using the Lux-Valve Plus system – part 2. The angle between the superior vena cava and tricuspid annulus is measured (a). The distances between the center of the tricuspid annulus and the free wall of the right ventricle and the right ventricle are measured (b). The recommended projection angle (parallel tricuspid annulus plane) is calculated (c). The access pathway is assessed including calcification, tortuosity and min average inner diameter of the vessel (d) Abbreviation: MPR, multiplanar reconstruction; TTVR, transcatheter tricuspid valve replacement.

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  Figure 5. Step-by-step intraprocedural guidance – part 1. (a) The delivery system is steered into the RV without wire by gradually curving. (b) Coaxility and depth are checked (here using MPR). The base of the graspers are placed around 1 cm ventricular to the TV annulus. Abbreviations: RV, right ventricle; MPR, multiplanar reconstruction; TV, tricuspid valve.

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  Figure 6. Step-by-step intraprocedural guidance – part 2. (a-c) Sheath is retrieved and the graspers exposed. The anterior and posterior graspers are deployed approximately 1 cm beneath the respective leaflets. Abbreviation: MPR, multiplanar reconstruction.

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  Figure 7. Step-by-step intraprocedural guidance – part 3. (a and b) Atrial skirt is released and final adjustments are made to minimze paravalvular leak. (c and d) The septal anchor is deployed.

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  Figure 8. Final Evaluation. (a) Final device deployment and the degree of residual TR are assessed using Color Doppler imaging, (b) three-dimensional echocardiography with and without multiplanar reconstruction (MPR), and (c) echo-CT fusion imaging Abbreviations: TR, tricuspid regurgitation; CT, computed tomography.