Related Experiment Video
Updated: Jan 9, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Intraprocedural 3- and 2-Dimensional Transesophageal Echocardiographic Evaluation of Tricuspid Valve Annular Geometry
Francesca Voce1, Anna Flo Forner1, Thilo Noack2
1Department of Anesthesia and Intensive Medicine, Herzzentrum Leipzig, Leipzig, Germany.
Objectives:
Tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) is an established technique for high-risk patients with secondary tricuspid regurgitation (TR). We hypothesized that the TV annulus diameters measured by intraprocedural 3-dimensional (3D) and 2-dimensional (2D) transesophageal echocardiography (TEE) would be reduced by the placement of 2 TV TEER clips. The primary aim of this prospective observational study was to quantify the immediate post-procedural change in minimum and maximum TV annulus diameters, as well as TV annulus circumference and area, measured by 3D TEE. The second aim was to identify whether these changes were best seen in the 2D mid-esophageal (ME) 4-chamber (4C) view or in the ME right ventricular inflow-outflow view. The third aim was to assess which changes in the TV annulus measurements correlated with procedural success.
Design:
In a prospective observational study, we analyzed intraprocedural 3D and 2D TEE datasets from 50 patients. We assessed the following parameters: maximum and minimum tricuspid annulus diameters, circumference, area, and TV annular diameters in 4C and right ventricular inflow-outflow views.
Setting:
Tertiary-care cardiac surgical center.
Participants:
Elective patients undergoing TV TEER.
Interventions:
None.
Measurements And Main Results:
After TV TEER, we observed a significant reduction in maximum TV annular diameter (mean, 48.14 ± 4.79 mm before intervention vs. 45.88 ± 4.78 mm after intervention; p < 0.001; -4.47% [confidence interval, 2.42%-6.52%]) and minimum TV annular diameter (mean, 38.00 ± 4.38 mm before intervention v 33.28 ± 5.35 mm after intervention; p < 0.001; -0.18% [confidence interval, 0.04%-0.32%]). All the other annular diameters were also significantly reduced. All measurements were significantly reduced by TV TEER in patients with residual TV equal to or less than moderate but not in other patients. The clip location did not seem to affect the changes in annular dimensions.
Conclusions:
Our data suggest that TV TEER results in a reduction in all annular measurements in patients with residual TR equal to or less than moderate.
