Multimodality imaging to plan and guide transcatheter tricuspid valve interventions

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Tricuspid regurgitation (TR) is a prevalent valvular heart disease with significant morbidity.
• Functional TR, caused by annular and ventricular dilatation, is more common than organic TR.
• Current surgical referral rates for significant TR remain low despite unfavorable natural history.

Purpose of the Study:

• To review the etiology and mechanisms of tricuspid regurgitation.
• To highlight the role of multimodality imaging in assessing TR severity and right ventricular function.
• To discuss the importance of imaging for patient selection in novel transcatheter TR therapies.

Main Methods:

• Comprehensive literature review of tricuspid regurgitation.
• Analysis of multimodality imaging techniques for TR assessment.
• Evaluation of device-specific criteria for transcatheter interventions.

Main Results:

• Functional TR is the predominant mechanism, driven by tricuspid annulus and right heart dilatation.
• Novel transcatheter devices are emerging for TR treatment, requiring precise patient selection.
• Multimodality imaging is essential for evaluating complex tricuspid anatomy and RV geometry.

Conclusions:

• Accurate pre-procedural assessment using multimodality imaging is vital for successful and safe transcatheter TR therapies.
• Imaging guides the evaluation of TR severity, RV dysfunction, and suitability for device implantation.
• Understanding TR mechanisms and imaging requirements is key to optimizing patient outcomes.