Transcatheter Tricuspid Valve Replacement in Carcinoid Heart Disease With Transjugular 3D Intracardiac...

Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system was the first Food and Drug Administration-approved TTVR therapy for clinical use in patients with symptomatic severe tricuspid regurgitation. Successful implantation is largely dependent on both fluoroscopic and transesophageal echocardiography (TEE) guidance. Imaging by TEE may be inadequate for confident and successful TTVR, which has led to adjunctive imaging with intracardiac echocardiography (ICE).

We present a unique case of TTVR with the EVOQUE system using transjugular 3-dimensional (3D) ICE guidance in symptomatic severe tricuspid regurgitation due to carcinoid syndrome in the setting of cardiogenic shock.

Transjugular 3D ICE is an effective adjunctive imaging modality for TTVR in patients who have inadequate imaging on TEE.

A transjugular approach for 3D ICE offers an alternative route compared with transfemoral for real-time visualization of the tricuspid valve leaflets with no interference with the valve delivery system.