Author + information
- Received March 28, 2019
- Revision received January 21, 2020
- Accepted January 29, 2020
- Published online August 19, 2020.
- Eustachio Agricola, MDa,
- Lluis Asmarats, MDb,
- Francesco Maisano, MDc,
- João L. Cavalcante, MDd,
- Shizhen Liu, MD, PhDe,
- Federico Milla, MDe,
- Christopher Meduri, MDe,
- Josep Rodés-Cabau, MDb,
- Mani Vannan, MBBSe and
- Philippe Pibarot, DVM, PhDb,∗ ()
- aSan Raffaele Scientific Institute, Milan, Italy
- bInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
- cUniversity Hospital of Zurich, Zurich, Switzerland
- dDepartment of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
- eMarcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
- ↵∗Address for correspondance:
Dr. Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, G1V-4G5, Québec, Canada.
• The volume of surgical and transcatheter valve interventions has increased in the past years.
• Multimodality imaging is essential for assessing patient’s eligibility for TV intervention, guiding procedure, and assessing outcomes.
• Key points for preprocedural imaging of TV intervention are accurate quantitation of TR severity, identification of TR mechanisms, and quantitation of RV dysfunction.
• TEE and cinefluoroscopy are keys for guiding the TV interventions.
• Fusion imaging and 3D TEE are helpful for more complex TV procedures such as TriClip and transcatheter annuloplasty.
Primary or secondary tricuspid regurgitation (TR) represents an important health care burden and challenge which has often been neglected or undertreated in the past. The expansion and reinforcement of the indications for tricuspid valve (TV) intervention in the 2017 editions of the guidelines as well as the introduction of transcatheter tricuspid valve intervention (TTVI) has considerably increased the attention of the community on the TV and the volume of TV interventions in the past years. Depending on the anatomic target, TTVI can be categorized as the following: 1) direct or indirect tricuspid restrictive annuloplasty; 2) direct (edge-to-edge repair) or indirect (coaptation device) restoration of leaflet coaptation; 3) heterotopic tricuspid valve implantation; and 4) transcatheter tricuspid valve replacement. Multimodality imaging has crucial role for the following: 1) patient selection for TTVI and procedure planning; 2) guiding and monitoring the procedure; and 3) assessing and following over time the results of the procedure. The key points for preprocedural imaging are: 1) accurate quantitation of TR severity; 2) proper identification of the mechanism(s) responsible for the TR; and 3) quantitation of RV dysfunction and pulmonary arterial hypertension. This imaging work-up is essential to select the right type of intervention for the right patient and TV. Transesophageal echocardiography and fluoroscopy imaging is also key for guiding the TTVI procedures and fusion between these 2 modalities may further enhance the quality of procedure guiding.
- computed tomography
- Doppler echocardiography
- fusion imaging
- tricuspid regurgitation
- tricuspid valve
- tricuspid valve intervention
- transcatheter valve therapy
- transesophageal echocardiography
Dr. Philippe Pibarot has received funding from Edwards Lifesciences for echocardiography corelab analyses in the field of transcatheter valve therapies with no personal compensation. Dr. Rodés-Cabau is a consultant for and has received institutional research grants from V-Wave. Dr. Francesco Maisano is a consultant for Abbott Vascular, ValtechCardio, Medtronic, Edwards Lifesciences, and Apica; is a founder of 4Tech; and has received royalties from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received March 28, 2019.
- Revision received January 21, 2020.
- Accepted January 29, 2020.
- 2020 American College of Cardiology Foundation
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