Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Figures

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  Figure 1. Example of 3D Doppler VC area using multiplanar reconstruction. (A,B) Reformation planes are aligned at the height of the 2D vena contracta during systole in two different planes. (C) A1 measures 1.65 cm2 in this case.

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  Figure 2. Integrated PISA with three-dimensional reconstruction of 6 PISAi during systole using a Nyquist limit of 22.8 cm/s. This reconstruction highlights the complex shape of the TR PISA and its change in size and shape across systole. The following formula is used to calculate the 3D-PISAi flow: 3D-PISAi flow = 3D-PISAi*Nyquist-velocity. The RegVoli of each PISAi is derived using the duration of each frame (1/Volume rate, in this case 0.05 s): RegVoli = 3D-PISAi flow*0.05. The total RegVol is the summation of the RegVoli of each frame.

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  Figure 3. Multiplanar reconstruction of the anatomic regurgitant orifice area (AROA) on MSCT images. (A) The reformation planes are adjusted at the leaflet tips during systole (20–40%). (B) The regurgitant orifice is delineated on the short axis. The AROA in this case is 0.7 cm2. (C) Correlation between TEE color-Doppler 3D vena contracta area (VCA) and MSCT AROA obtained with multiplanar reconstruction.

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  Figure 4. Edge-to-edge repair case. (A) Assessment of the baseline valve anatomy using transesophageal 3D echocardiography (A=anterior leaflet; S=septal; p=posterior). (B) Orientation of the clip perpendicular to the antero-septal commissure using the transgastric view. (C) Insertion of the delivery system into the right atrium under fluoroscopic guidance (projection: RAO 20) after implantation of a MitraClip in the mitral valve (arrow). (D,E) Positioning of the clip in the postero-septal commissure using x-plane mid-esophageal view (closer to the aorta is a first clip in the antero-septal commissure, *pacemaker lead). (F) Final result after implantation of 2 clips.

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  Figure 5. Annuloplasty case. (A–C) Preprocedural MSCT planning of the Cardioband implantation (projection A: RAO 10—CRAN 10, B: LAO 76—CAU 15; green line: reconstruction of the RCA). (A,B) Anticipated localization of the screws in relationship with the RCA. (C) Measurements of the distance between annulus and RCA. (D) Angiography of the RCA after Cardioband cinching (projection: LAO 52—CAU 10) with “en face” view of the TV. The ostium and proximal part of the RCA are in close proximity to anterior leaflet while the periphery is close to the posterior leaflet. (E) MultiView echocardiography for intra-procedural guiding of screw implantation allowing catheter localization in three planes.

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  Figure 6. Heterotropic transcatheter caval valve implantation. (A) 3D MSCT reconstruction of the vena cava inferior, the liver veins and the right heart cavities. (B) Schematic depiction of the NVT Tricento bicaval stenting device. (C) Fluoroscopic image of the implanted stent (projection: RAO 45). (D,E) Transthoracic echocardiographic imaging of the implanted device in his long and short axis from subxyphoidal at 30-day follow-up. (F) Depiction of the prosthesis and its relation to the right atrium and the hepatic vein in computed tomography. (Asterisk: valve element; arrow: leadless pacemaker; plus: hepatic vein).