Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies

Abstract

Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.

Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention

“…Cross-sectional area, perimeter, septolateral, and AP diameters can be obtained with excellent intra-and interobserver reproducibility (25). The cross-sectional area and perimeter can be assessed by planimetry or using semiautomated software (32)(33)(34). The septal-lateral diameter is the maximal distance in septal to the lateral direction and coincides with the annulus measurement in the four-chamber view.…”

“…Moreover, since the typical non-planar saddleshaped structure of the tricuspid annulus, the 2D approach for obtaining measurements does not accurately address the complex annular geometry. Therefore, a dedicated 3D semiautomated software can be valuable in overcoming this disadvantage (Figure 4) (32)(33)(34).…”

“…Furthermore, assessment of the RCA course and its distance to the annulus, simulation of virtual device implantation, and prediction of an optimal projection angle are part of a comprehensive CT-based pre-procedural assessment ( Figure 6 ) ( 34 ).…”

“…The echocardiographic 3D en-face view of the TV, the transgastric short axis, and the mid/deep esophageal RV inflow/outflow with simultaneous biplane view permit accurate assessment of the leaflets and commissures, as well as the largest coaptation gap. Preoperative CT imaging is not routinely performed for screening patients with TR who are candidates for edge-to-edge valve repair ( 34 ).…”

Right Heart Morphology of Candidate Patients for Transcatheter Tricuspid Valve Interventions

“…4,22 Computed tomography and magnetic resonance imaging can quantify these missing features but require time-intensive manual approaches significantly limiting their routine quantification. 2,6 A more comprehensive knowledge of these right heart morphological features, their variation, and complexities exhibits both possibility and promise for aiding transcatheter system design, sizing, and device-procedure development.…”