TEE Guiding for T-TEER by Using Multiplanar Reconstructions in a Patient With Previous Surgical Annuloplasty

Fabian Barbieri ¹, Vasileios Exarchos ², Mario Kasner ²

⁰Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany; Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany.

Jacc. Case Reports +

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April 18, 2025

View abstract on PubMed

Summary

Transesophageal echocardiography can have imaging limitations during tricuspid transcatheter edge-to-edge repair. Multiplanar reconstructions using 3D transesophageal echocardiography improve visualization and safety, especially with annuloplasty rings present.

Area Of Science

Cardiovascular Imaging
Interventional Cardiology
Echocardiography

Background

Transesophageal echocardiography (TEE) is crucial for guiding tricuspid transcatheter edge-to-edge repair (TTVR).
Imaging limitations during TEE can complicate TTVR procedures and increase complication risks.
Pre-existing surgical tricuspid annuloplasty rings can further degrade imaging quality.

Purpose Of The Study

To present an imaging technique to overcome TEE limitations in TTVR.
To demonstrate the utility of multiplanar reconstructions (MPR) from 3D-TEE.
To highlight MPR's role in challenging TTVR cases with annuloplasty rings.

Main Methods

Utilized 3-dimensional transesophageal echocardiography (3D-TEE) with multiplanar reconstructions (MPR).
Applied MPR to visualize challenging anatomy in a patient with a surgical tricuspid annuloplasty ring.
Performed TTVR using a single device under TEE guidance.

Main Results

Successfully implanted a single TTVR device.
Reduced tricuspid regurgitation from massive to moderate.
MPR provided enhanced visualization of leaflet grasping and insertion points.

Conclusions

Multiplanar reconstructions are valuable for improving TEE imaging quality in TTVR.
MPR can enhance visualization of critical structures like leaflet insertion and grasping.
This technique may improve the safety and efficacy of TTVR, particularly in patients with prior annuloplasty rings.

Keywords:

3-dimensional echocardiography TEER interventional echocardiography multiplanar reconstruction surgical annuloplasty tricuspid regurgitation tricuspid transcatheter edge to edge repair