Multimodality imaging for transcatheter tricuspid valve repair and replacement

Figures

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  Figure 1. Transcatheter Tricuspid Valve Devices. (A) TriClip (Abbott Vascular, Santa Clara, California, USA); (B) PASCAL system (Edwards Lifesciences, Irvine, California, USA); (C) EVOQUE system (Edwards Lifesciences, Irvine, California, USA); (D) LuX-Valve (Jenscare Biotechnology Co., Ningbo, China); (E) Cardiovalve (Boston Medical, Shrewsbury, MA, USA); (F) Intrepid valve (Medtronic Plc, Minneapolis, MN, USA); (G) Cardioband tricuspid valve reconstruction system (Edwards Lifesciences, Irvine, California, USA); (H) Tri-Ring annuloplasty system (Cardiac implants, California, USA; (I) TRICENTO system (Medira AG, Balingen, Germany); (J) TricValve (NVT, Muri, Switzerland).

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  Figure 2. Tricuspid valve nomenclature classification scheme (reproduced with permission from (14)).

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  Figure 3. Classification of tricuspid regurgitation (16). CIED, cardiac implantable electronic device; FTR, functional tricuspid regurgitation; TR, tricuspid regurgitation; RA, right atrium; TA, tricuspid annulus; RHD, rheumatic heart disease.

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  Figure 4. Transesophageal echocardiography imaging levels (reproduced with permission from (32)). Comprehensive tricuspid assessment requires imaging from multiple esophageal and gastric windows: (A) mid esophageal level, (B) deep esophageal level, (C) transgastric, and (D) deep transgastric. A, anterior leaflet; Ao, aorta; LA, left atrium; LV, left ventricle; P, posterior leaflet; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; S, septal leaflet.

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  Figure 5. Biplane TEE Imaging of the tricuspid valve (reproduced with permission from (32)). The mid-esophageal right ventricular inflow-outflow view (at ∼50–80°) is considered the TV 'commissural' view with the anterior (blue line) and posterior (green line) leaflets imaged and the septal leaflet (yellow line) behind the imaging plane. Moving the orthogonal biplane cursor towards the posterior wall (A) images the posterior and septal leaflets. Moving the orthogonal biplane cursor towards the aorta (B) images the anterior leaflet near the aorta and the septal leaflet.

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  Figure 6. Three-dimensional (3D) TEE multiplanar reconstruction. 3D imaging with multiplanar reconstruction of the tricuspid valve from the mid esophageal window in mid diastole. The 3D block is presented in the ‘non rotated’ view with the reconstructed long axis 2D images displayed in the familiar ‘commissural’ and corresponding septo-lateral orthogonal image. Direct measurement of tricuspid annular dimensions is performed from planimetry of the 2D short axis image aligned with the tricuspid annulus.

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  Figure 7. Proposed workflow algorithm for device class selection for transcatheter tricuspid valve intervention (reproduced with permission from (93)). TEE, transesophageal echocardiogram; CMR, cardiac magnetic resonance imaging; CCT, cardiac computed tomography; CIED, cardiac implantable electronic devices; TR, tricuspid regurgitation; PAH, pulmonary arterial hypertension; RV, right ventricular; IE, infective endocarditis; AF, atrial fibrillation; RCA, right coronary artery; TEER, transcatheter edge to edge repair; TTVR, transcatheter tricuspid valve replacement.

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  Figure 8. Leaflet approximation devices anatomical limitations (10). DE, deep esophageal; TR, tricuspid regurgitation; CIED, cardiac implantable electronic devices; RV, right ventricle.

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  Figure 9. Orthotopic valve replacement anatomic limitations (10). CIED, cardiac implantable electronic devices; RV, right ventricle.

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  Figure 10. Annuloplasty devices anatomic limitations (10). TR, tricuspid regurgitation; CIED, cardiac implantable electronic devices; RCA, right coronary artery.

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  Figure 11. Heterotopic valve implant anatomic limitations (10, 60). BT, braciocephalic trunk; Az, azygos vein; Ao, aorta; RPA, right pulmonary arery; SVC, superior vena cava; RA, right atrium; RV, right ventricle; HV hepatic vein; IVC, inferior vena cava; SVC superior vena cava; LA left atrium.