Intraprocedural Guidance for Transcatheter Tricuspid Valve Replacement in Challenging Scenarios

TRANSCATHETER TRICUSPID VALVE REPLACEMENT (TTVR) IS A THERAPEUTIC OPTION FOR PATIENTS with symptomatic severe tricuspid regurgitation, offering a less invasive alternative therapy to surgery. Currently, transesophageal echocardiography (TEE) and fluoroscopy are the primary imaging modalities used during TTVR. TEE offers real-time visualization of the valve leaflets and surrounding structures, and fluoroscopy provides a complementary perspective enabling precise catheter manipulation, device positioning and deployment. Intraprocedural imaging guidance for TTVR cases has been described previously for the Evoque TTVR system (Edwards Lifesciences LLC).1 However, patients may have limited esophageal TEE views because of distal relations of esophagus in chest cavity to the right heart, cardiac rotation, or significant acoustic shadowing from prosthetic material (eg, device leads, prior edge-to-edge repair devices) Adjunctive 3-dimensional intracardiac echocardiography and TEE transgastric imaging with 3-dimensional multiplanar reconstruction may be utilized in these challenging scenarios. Our paper aims to provide a step-by-step description of intraprocedural multimodality imaging guidance on Evoque TTVR, particularly in challenging scenarios, to optimize procedural safety and efficacy (Figures 1 to 5).