Multimodality Imaging for Evaluation of Bicaval Valved Stent Implantation in Severe Tricuspid Regurgitation

Figures

• 

  Figure 1. Schematic Measurements and Preprocedural and Postprocedural CT CT = computed tomography; IVC = inferior vena cava; RA = right atrium; RV = right ventricle; SVC = superior vena cava; V. = vena.

• 

  Figure 2. Case 1 Fluoroscopy after prosthesis deployment in (A) diastole and (B) systole. (C) Computed tomography depicting movement of the prosthesis in systole (pink) and diastole (white).

• 

  Figure 3. Case 2 (A) Baseline cardiac magnetic resonance showing pleural effusion (yellow arrows) and right ventricular dilation. (B) At 6-month follow-up, cardiac magnetic resonance showing resolution of pleural effusion (yellow arrow) and reduced right ventricular dimensions (the white arrow points to the prosthesis). (C) Discharge echocardiography and (D) computed tomography follow-up for evaluation of prosthesis positioning ensuring alignment of the caudal prosthesis end with the caval-hepatic vein junction (C, white dotted line); the asterisk shows the valve element, and the plus sign shows endothelialization of the prosthesis.

• 

  Figure 4. Case 3: Echocardiography (A) Baseline transthoracic echocardiography with color Doppler showing severe tricuspid regurgitation (4-chamber view). (B) Transthoracic echocardiography at 1-month follow-up showing the regurgitant jet tangentially affecting the prosthesis (asterisk); the arrow shows the direction of the regurgitant jet.

• 

  Figure 5. Case 3: CT Reconstruction (A) Part comparison and heat map of the prosthesis. Red represents maximal deformation of the stent parts (assessed in 30% of the RR interval [ie, systole] vs 80% [ie, diastole]), whereas green represents minimal stent part deformation. Maximal deformation is observed on the posterior side of the stent. (B) Maximum intensity projection of the computed tomography scan with fracture of the stent frame (red circle). Congruent with maximal deformation, the stent fracture is located on the posterior side of the stent.