Computed tomography for planning transcatheter tricuspid valve therapy

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Percutaneous transcatheter tricuspid valve therapy offers an alternative for patients with severe tricuspid regurgitation (TR) unsuitable for surgery.
• Comprehensive anatomical assessment is crucial for successful device implantation.

Purpose of the Study:

• To evaluate the utility of computed tomography (CT) for detailed anatomical assessment of the tricuspid valve, right ventricle (RV), and vena cavae.
• To investigate the spatial relationship between the tricuspid valve annulus and the right coronary artery (RCA) in relation to TR severity.
• To determine the implications of these anatomical findings for patient suitability for current transcatheter tricuspid valve technologies.

Main Methods:

• A retrospective analysis of 250 patients undergoing CT scans was performed.
• Patients were categorized based on the severity of tricuspid regurgitation (TR ≥3+ vs. TR <3+).
• Detailed measurements of the tricuspid annulus, RV, vena cavae, and the course of the RCA relative to the tricuspid annulus were obtained.

Main Results:

• Patients with severe TR (TR ≥3+) exhibited significantly larger tricuspid annulus, RV, and vena cavae dimensions.
• The RCA coursed along the tricuspid valve annulus in 64.8% of all patients.
• A less favorable RCA course (≤2.0 mm from the annulus) for annuloplasty techniques was observed in a notable percentage of patients with severe TR, particularly near the anterior and posterior leaflets.

Conclusions:

• CT provides a systematic approach to anatomical evaluation for transcatheter tricuspid valve interventions.
• Understanding the spatial relationship between the RCA and the tricuspid annulus is critical for procedural planning.
• This anatomical assessment aids in defining patient suitability for existing transcatheter tricuspid valve devices.