Right Heart Morphology of Candidate Patients for Transcatheter Tricuspid Valve Interventions

Abstract

Purpose This study quantitatively evaluated the phasic right heart morphology of candidate patients for a transcatheter tricuspid valve intervention (N=32) and of subjects with trace to no tricuspid regurgitation (N = 14). Methods Cardiac computed tomography angiography (CCTA) and transthoracic/transesophageal echocardiography (TTE/TEE) images were analyzed using dedicated research and clinical software. Using CCTA, the phasic right atrial and ventricular volumes, annulus dimensions, annulus-to-right coronary artery (RCA) distances, circumferential topography of the annular tissue shelf, vena cava dimensions (inferior and superior), vena cava positions, axis angles, and annular excursions were quantified. Using TTE/TEE, leaflet geometry, regurgitation, hemodynamics, and heart function were quantified. Measurements within and between groups were quantitatively compared with regression analyses to explore relationships between right heart features. Results The phasic position and orientation of the vena cava and the circumferential topography of the annular tissue shelf were quantitatively presented for the first time. The candidate patient group exhibited greater chamber dimensions, enlarged vena cava, distended vena cava positions, positional shallowing of the annular tissue shelf, geometric annular distortion, leaflet distention, moderate or greater regurgitation, and impaired ventricular function. Atrial volume correlated strongly with directional vena cava positions as well as with annular dimensions. Annulus-to-RCA distances and annular excursions were comparable between groups. Conclusions This study provides new and further insight to the right heart morphology and functional characteristics of candidate patients for a transcatheter tricuspid valve intervention. These data provide a platform from which these patients can continue to be better understood for further improving transcatheter system design and use.

Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures

“…Specific protocols for CT acquisition, dedicated to the right heart chambers, are needed for optimizing the image quality for analysis [8,15,22,23]. In addition, several CT parameters have been tested that specifically support different transcatheter therapies [11][12][13][14][15]. Our contrast media protocol is specifically tailored to our institutional scanners and adapted from previously published methods [15,23].…”

“…Each TTVI requires specific imaging protocols to evaluate the anatomical feasibility and predict outcomes after the procedure. Likewise, different CT parameters have been tested so far in order to support the screening process and the development of novel transcatheter therapies [11][12][13][14][15].…”

Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study

“…Each TTVI needs specific imaging protocols to evaluate the anatomical feasibility and outcomes of the potential procedure. Several parameters have been studied so far and they have been found to help in the decision-making process and support the development of novel transcatheter therapies [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”