Advancement in pre- and peri-procedural imaging

Only recently, pathophysiology and relevance of tricuspid regurgitation (TR) has been acknowledged but remains still poorly understood. The rising interest in this valve disease has also fuelled the efforts to define and improve imaging modalities. Vice versa, understanding tricuspid disease initiation and progress, validation, and quantification as well as choice and monitoring of treatment critically rely on reproducible and sensitive imaging capabilities. The latter is dominated by ever improving ultrasound-based analysis applied from the outside, the oesophagus or within the heart. The increasing appreciation of the relevance of TR and the rapid evolution of catheter-based treatment options has stimulated engineers and industry to swiftly improve established methodologies as well as to provide novel tools including three-dimensional intra-cardiac echocardiography and fusion imaging. Ultrasound is necessarily complemented by MRI and CT in the tricuspid space urging the cardiologist to gain also expertise in these modalities. In this review, we will focus on the quantitative and reproducible measurements to quantify TR and concomitant left and right heart anatomy, function, and haemodynamics before, during and after treatment. In addition, we will share insights on adjunct and future technologies.