Echocardiographic guidance in transcatheter tricuspid valve interventions

Echocardiographic guidance plays a pivotal role in pre-procedural screening and intraprocedural guidance for transcatheter tricuspid valve interventions (TTVI). Pre-procedurally, comprehensive transesophageal echocardiography (TEE) is essential to understand the tricuspid regurgitation (TR) mechanism, quantify TR severity, tricuspid leaflet morphology, right ventricular function/size, and help determine transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) selection based on underlying tricuspid valve anatomy. Interprocedurally, the use of real-time three-dimensional transesophageal echocardiography (3D-TEE) together with fluoroscopy allows precise guidance of device steering, leaflet insertion, and deployment while minimizing complications, especially in technically challenging tricuspid valve anatomy. Post-device deployment echocardiography assists in the assessment of residual TR, paravalvular leak, transvalvular gradient, right ventricular function changes, and the occurrence of pericardial effusion. As device technologies and indications for TTVI continue to expand, high-quality echocardiographic protocols and expertise are central to optimizing patient selection, procedural safety, and long-term outcomes in transcatheter treatment of tricuspid valve regurgitation.