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Traverse angle computations are a critical component of surveying, used to compute the internal angles within a closed traverse. A traverse consists of a series of connected lines forming a closed loop, often used for land boundary delineation or mapping. Calculating the internal angles ensures accuracy in the traverse geometry and is essential for checking survey data integrity.The process begins with known azimuths and bearings of the traverse sides. Internal angles at each vertex are...
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Computed tomography for transcatheter tricuspid valve development.

Paul-Matthieu Chiaroni1, Julien Ternacle2, Jean-François Deux3

  • 1Interventional Cardiology, Centre Expert Valvulaire, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

European Radiology
|August 28, 2019
PubMed
Summary

Transcatheter tricuspid valve replacement (TTVR) offers an alternative for patients ineligible for surgery. Computed tomography analysis reveals the transjugular venous route is more suitable for TTVR due to its straighter trajectory.

Keywords:
Heart valve prosthesis implantationRadiology, interventionalTomography, X-ray computedTricuspid regurgitation

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Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe symptomatic tricuspid regurgitation (TR) often precludes surgical repair due to patient comorbidities.
  • Transcatheter tricuspid valve replacement (TTVR) is an emerging alternative, but optimal delivery techniques and prosthesis designs are under development.
  • Computed tomography (CT) analysis can elucidate challenges and venous access determinants for TTVR.

Purpose of the Study:

  • To assess the challenges associated with transcatheter tricuspid valve replacement (TTVR).
  • To determine the optimal venous access route for TTVR using computed tomography (CT) analysis.
  • To evaluate anatomical factors influencing TTVR delivery and prosthesis design.

Main Methods:

  • Analysis of 195 end-diastolic cardiac CT scans from patients undergoing procedures for severe TR, transcatheter aortic valve replacement, or left atrial appendage closure.
  • Comparison of anatomical parameters between patients with and without severe TR.
  • Measurement of tricuspid annulus (TA) dimensions, angulation to vena cavae, and distances to adjacent cardiac structures.

Main Results:

  • Patients with severe TR exhibit a larger and rounder tricuspid annulus (TA) compared to controls.
  • The angle from the TA to the inferior vena cava is tighter than to the superior vena cava.
  • The coronary sinus ostium is closely situated to the TA, and a moderator band is present.

Conclusions:

  • The transjugular venous route offers a straighter and more reproducible access for TTVR compared to the transfemoral route.
  • Prosthesis design for TTVR must account for the proximity of the coronary sinus, presence of a moderator band, and enlarged TA dimensions.
  • The transjugular approach is likely the preferred venous access for TTVR procedures.