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Cammalleri V, Carpenito M, Bono MC, Mega S, Ussia GP, Grigioni F. Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention. Front Cardiovasc Med 2021; 8:778445. [PMID: 34869692 PMCID: PMC8639182 DOI: 10.3389/fcvm.2021.778445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Nowadays, severe symptomatic tricuspid regurgitation (TR) affects millions of persons worldwide. However, the benefit of surgical correction of isolated secondary TR remains controversial because of the increased risk of periprocedural mortality and morbidity. In recent years, novel transcatheter tricuspid valve interventions (TTVI) were developed to treat TR, so that TTVI is currently considered in symptomatic, inoperable, anatomically eligible patients. TTVI can be divided into these five domains: edge-to-edge leaflet repair, tricuspid annuloplasty, caval implants, spacer, and total valve replacement. Each transcatheter intervention needs specific imaging protocols for assessing the anatomical feasibility and consequentially predicting the procedural success. This review summarizes the available multimodality imaging tools for screening patients with TR, and identifies anatomical characteristics to choose the best option for the patient.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Myriam Carpenito
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Maria Caterina Bono
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Simona Mega
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
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2
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da Rocha E Silva JG, Ruf TF, Hell MM, Tamm A, Geyer M, Munzel T, von Bardeleben RS, Kreidel F. Transgastric imaging-The key to successful periprocedural TEE guiding for edge-to-edge repair of the tricuspid valve. Echocardiography 2021; 38:1948-1958. [PMID: 34729813 DOI: 10.1111/echo.15196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Intraprocedural transesophageal echocardiography (TEE) guidance plays an essential role in transcatheter repair therapy of the tricuspid valve (TV). So far, several different imaging concepts are in use. We propose an imaging protocol that fully addresses the morphological complexity of the TV and further offers efficacious workarounds for the frequently occurring restrictions of TV imaging in edge-to-edge repair of the TV. As a tertiary referral center with a large experience of more than 250 cases of transcatheter edge-to-edge repair (TEER) of the TV performed at the Heart Valve Center in Mainz/Germany, we have constantly adapted our peri-interventional echocardiographic approach to accomplish both. As a key measure for success, we intensely rely on the transgastric acoustic windows that not only deliver high-resolution information on the morphology of the TV and all relevant procedural steps but also help to avoid the frequent shadowing artifacts experienced in transesophageal imaging.
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Affiliation(s)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Tamm
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Munzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | | | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
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3
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Schlossbauer SA, Faletra FF, Paiocchi VL, Leo LA, Franciosi G, Bonanni M, Angelini G, Pavon AG, Ferrari E, Ho SY, Hahn RT. Multimodality Imaging of the Anatomy of Tricuspid Valve. J Cardiovasc Dev Dis 2021; 8:jcdd8090107. [PMID: 34564125 PMCID: PMC8469874 DOI: 10.3390/jcdd8090107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Even though the tricuspid valve is no longer “forgotten”, it still remains poorly understood. In this review, we focus on some controversial and still unclear aspects of tricuspid anatomy as illustrated by noninvasive imaging techniques. In particular, we discuss the anatomical architecture of the so-called tricuspid annulus with its two components (i.e., the mural and the septal annulus), emphasizing the absence of any fibrous “ring” around the right atrioventricular junction. Then we discussed the extreme variability in number and size of leaflets (from two to six), highlighting the peculiarities of the septal leaflet as part of the septal atrioventricular junction (crux cordis). Finally, we describe the similarities and differences between the tricuspid and mitral valve, suggesting a novel terminology for tricuspid leaflets.
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Affiliation(s)
- Susanne Anna Schlossbauer
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Francesco Fulvio Faletra
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
- Correspondence: ; Tel.: +41-91-805-3179; Fax: +41-91-805-3167
| | - Vera Lucia Paiocchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Laura Anna Leo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Giorgio Franciosi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Michela Bonanni
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Gianmarco Angelini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London SW36NP, UK;
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA;
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Winkel MG, Brugger N, Khalique OK, Gräni C, Huber A, Pilgrim T, Billinger M, Windecker S, Hahn RT, Praz F. Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions. Front Cardiovasc Med 2020; 7:60. [PMID: 32432125 PMCID: PMC7214677 DOI: 10.3389/fcvm.2020.00060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.
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Affiliation(s)
- Mirjam G. Winkel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Omar K. Khalique
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Rebecca T. Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Fabien Praz
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
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Peters AC, Gong FF, Rigolin VH. Three-dimensional echocardiography for the assessment of the tricuspid valve. Echocardiography 2020; 37:758-768. [PMID: 32315483 DOI: 10.1111/echo.14658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/03/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022] Open
Abstract
Tricuspid valve pathology is increasingly recognized as an important contributor to patient morbidity. Accordingly, interest in transcatheter interventions for tricuspid valve disease has continued to grow. Echocardiographic imaging of the tricuspid valve has therefore become an integral component of patient assessment and the essential imaging modality for interventional procedures. The need for improved tricuspid valve imaging has highlighted the variability in tricuspid valve anatomy and the difficulties of using two-dimensional (2D) echocardiography alone to determine the location and type of tricuspid valve disease. Here, three-dimensional (3D) imaging using tools such as biplane imaging, multiplanar reconstruction and live 3D acquisition allow a more accurate and efficient evaluation of the tricuspid valve. The 3D imaging of the tricuspid valve is often focused on transesophageal echocardiography, but the more anterior location of the tricuspid valve also lends itself to assessment with transthoracic echocardiography. In this review, we will examine how 3D imaging can complement and enhance the information obtained from 2D echocardiography, and present novel applications for the quantitation of valvular disease and its utility in intraprocedural imaging.
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Affiliation(s)
- Andrew C Peters
- Department of Medicine, Division of Cardiovascular Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fei Fei Gong
- Department of Medicine, Division of Cardiovascular Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vera H Rigolin
- Department of Medicine, Division of Cardiovascular Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ro R, Tang GHL, Seetharam K, Khera S, Sharma SK, Kini AS, Lerakis S. Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair. J Am Heart Assoc 2020; 9:e015682. [PMID: 32089056 PMCID: PMC7335573 DOI: 10.1161/jaha.119.015682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Ro
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Karthik Seetharam
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Sahil Khera
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Samin K Sharma
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Annapoorna S Kini
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
| | - Stamatios Lerakis
- Division of Cardiology Icahn School of Medicine at Mount Sinai Mount Sinai Hospital New York NY
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Multi-Modality Imaging in the Evaluation and Treatment of Tricuspid Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:77. [PMID: 30094651 DOI: 10.1007/s11936-018-0672-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to cover the epidemiology of tricuspid regurgitation (TR), anatomy of the tricuspid valve (TV), and the mechanisms and modern treatment of TR. The focus will be on the role of echocardiography, cardiac CT, and MRI to determine the mechanism, severity, and management strategies of TR. RECENT FINDINGS The evaluation and management of TR is a rapidly growing field with significant advances in both imaging and interventions. Important advances have been made to understand TV anatomy and physiology in 3D echo, CT, and MRI. Additional understanding of the abnormal outcomes in both primary TR and secondary TR have been appreciated. Multiple transcatheter devices have reached the stage of early trials in high surgical risk cohorts with favorable initial findings. TR is a significant cardiovascular problem and vastly undertreated in the present era. There has been tremendous growth in knowledge of mechanisms of TR, its prognostic implications, timing of intervention, and development of novel treatment strategies. Multimodality imaging plays a key role in evaluation and treatment of this condition.
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