Transjugular Tricuspid Valve-in-Ring Replacement Using the Novel System Under Three-Dimensional Printing Guidance

Figures

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  Figure 1. Preoperative imaging assessments were utilized to formulate procedure. (A, B) Preoperative transesophageal echocardiography measurements showed the severe tricuspid regurgitation after failed surgical annuloplasty ring repair: regurgitation volume = 36 mL; peak velocity = 2.96 m/s. (B–H) Computed tomography angiography was used to evaluate the possibility of performing the procedure. (B) The average diameter and the area of the tricuspid annulus (TA) were approximately 37.2 mm and 10.8 cm2, respectively. (C) The area of the 10 mm plane over the TA is 43.5 cm2. (D) The angle between the ventricular septum and tricuspid annular plane is 96°, and the thickness of the anchoring position of ventricular septum is 9.8 mm, both of which ensure that the stent is anchored. (E) The maximum length of the tip of the delivery system that can pass vertically through the TA plane is 55.3 mm. (F) The delivery system needs to be adjusted to 99° to ensure coaxiality between the stent and the TA. (G) The projection angle of the released implanted valve was RAO38°, CAU2°. (H) The minimum mean diameter of the access vessel is approximately 12.3 mm, ensuring that the delivery system can be manipulated…

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  Figure 2. The LuX‐Valve Plus system and three‐dimensional printing. (A, B) The prosthesis and the novel delivery system (33 Fr and 28 Fr) of the LuX‐Valve Plus system. (C–F) The three‐dimensional reconstruction and the patient‐specific three‐dimensional printed model are seen in the right atrium and from the ventricular view. The yellow or the black parts are the tricuspid annuloplasty rings. (G–I) The patient‐specific three‐dimensional printed model was used to simulate and formulate a procedure plan. The delivery system was bent to 99° to ensure the coaxiality; the position of the prosthesis can be observed; and there is no paravalvular leak. RA, right atrium; RV, right ventricle.

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  Figure 3. Perioperative main steps of transcatheter tricuspid valve‐in‐ring replacement as seen in fluoroscopic images: (A) Severe tricuspid regurgitation. (B–E) Stent positioning, releasing, and anchoring. (F) There is no regurgitation. (G, H) Postoperative three‐dimensional transesophageal echocardiography and follow‐up echocardiography show that the stent is stable and that the position is accurate without paravalvular leakage and intra‐ring regurgitation.

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  Figure 4. The stability of the stent and the function of the valve are confirmed by postoperative evaluation. (A–D) Postoperative three‐dimensional reconstructions and three‐dimensional printed models show the well‐functioning stent. (D, E) The uniformly distributed stress area in the shape of a yellow triangle is enclosed by three anchoring components, and the rigid ring is locked in place by two anchoring pins that ensured the stability of the stent. (F) Paravalvular leakage and intra‐ring regurgitation can be repaired by the atrial disc. PVL, paravalvular leak; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract.