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Assessment After Surgery or Interventional Procedures on the Tricuspid Valve

  • Luigi P. BadanoEmail author
  • Arnaldo Rabischoffsky
  • Marco Previtero
  • Roberto Carlos Ochoa-Jimenez
Chapter

Abstract

The association of better understanding of the role of tricuspid regurgitation (TR) as an independent predictor of patients’ morbidity and mortality, and the advent of novel transcatheter devices to treat severe TR have contributed to increase the interest of cardiologists and cardiac surgeons about the tricuspid valve (TV). The number of transcatheter interventions for TR is growing, and procedural success relies significantly on the pre-procedural evaluation of the anatomy of the TV, etiology and severity of TR, right ventricular size and function, and importantly, the anatomic relationships of the TV. The role of three-dimensional echocardiography and multimodality imaging in patient selection and procedural planning for transcatheter TV repair is reviewed.

Keywords

Tricuspid valve Three-dimensional echocardiography Fusion imaging Multimodality imaging Tricuspid valve surgery Transcatheter procedures Tricuspid valve repair devices Functional tricuspid regurgitation 

Supplementary material

Video 22.1a

Two-dimensional apical 4-chamber view showing lack of coaptation of the tricuspid leaflets in a patient with De Vega annuloplasty Tricuspid valve De Vega annuloplasty failure and severe tricuspid regurgitation (AVI 44966 kb)

Video 22.1b

Two dimensional color Doppler showing a large vena contracta and regurgitant jet in a patient with De Vega annuloplasty failure and severe tricuspid regurgitation (AVI 47418 kb)

Video 22.1c

Transesophageal three-dimensional volume rendering of the tricuspid valve seen from the atrial perspective in a patient with De Vega annuloplasty failure and severe tricuspid regurgitation (AVI 8941 kb)

Video 22.1d

Multislice display of a 3DE color data set to identify and planimeter the area of the vena contracta in a patient with De Vega annuloplasty failure and severe tricuspid regurgitation (AVI 8652 kb)

Video 22.2a

(Left) Three-dimensional volume rendering of the open prosthetic tricuspid annulus visualized from the atrial perspective with the site of detachment of the prosthetic tricuspid annulus after surgical mitral and tricuspid annuloplasty (AVI 6370 kb)

Video 22.2b

(Right) T-dimensional color flow showing the double regurgitant flow through the annulus and also through the perinannular orifice in a patient with detachment of the prosthetic tricuspid annulus after surgical mitral and tricuspid annuloplasty. AO aorta, MA prosthetic mitral annulus, TA prosthetic tricuspid annulus (AVI 7015 kb)

Video 22.3a

(Left) Transthoracic three-dimensional volume rendering of the bioprosthesis visualized from the atrial perspective showing extensive pannus overgrowth and the endocarditis vegetation prolapsisng in systole (AVI 8369 kb)

Video 22.3b

(Right) Transthoracic three-dimensional volume rendering of the bioprosthesis visualized from the ventricular perspective showing multiple large vegetations (AVI 9912 kb)

Video 22.4b

Transthoracic color flow imaging to assess the severity of residual regurgitation after the MitraClip transcatheter repair of severe tricuspid regurgitation (MOV 2065 kb)

Video 22.4c

Transthoracic three-dimensional volume rendering showing the position of the clips and their stability after the MitraClip transcatheter repair of severe tricuspid regurgitation (MOV 1445 kb)

Video 22.4d

Transthoracic three-dimensional volume rendering using a transversal cut plane to visualize the Mitraclips from the ventricular perspective. Proper rotation of the cut plane reveals that three clips have been implanted: two on the commissure between the septal and anterior leaflets, and one between the septal and posterior leaflets. RA right atrium, RV right ventricle (MOV 1511 kb)

Video 22.5a

Biplane imaging of the transcatheter tricuspid valve implant using the Gate™ Tricuspid Valve Stent (MOV 167 kb)

Video 22.5b

transthoracic three-dimensional volume rendering of the Gate™ Tricuspid Valve Stent. seen en face from the ventricular perspective (MOV 135 kb)

Video 22.5c

Multislice display with the region of interest confined at the level of the valve to visualize the shape of the stent and the motion of the leaflets of the Gate™ Tricuspid Valve Stent (MOV 155 kb)

Video 22.5d

Transthoracic three-dimensional color Doppler of the of the Gate™ Tricuspid Valve Stent seen en face from the ventricular perspective to visualize the origin of the mild intraprosthetic jet (MOV 102 kb)

Video 22.6a

(Left) Transesophageal three-dimensional echocardiography imaging during MitraClip position in a patient with severe tricuspid regurgitation. Volume rendered longitudinal cut plane to assess the grasping of both leaflets and the stability of the clip (AVI 4584 kb)

Video 22.6b

(Right) Transesophageal three-dimensional echocardiography imaging during MitraClip position in a patient with severe tricuspid regurgitation. Volume rendered en face view of the valve from the ventricular perspective to localize the position of the clips (AVI 5105 kb)

References

  1. 1.
    Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–9.CrossRefGoogle Scholar
  2. 2.
    Badano LP, Muraru D, Enriquez-Sarano M. Assessment of functional tricuspid regurgitation. Eur Heart J. 2013;34(25):1875–85.CrossRefGoogle Scholar
  3. 3.
    Neuhold S, Huelsmann M, Pernicka E, et al. Impact of tricuspid regurgitation on survival in patients with chronic heart failure: unexpected findings of a long-term observational study. Eur Heart J. 2013;34:844–52.CrossRefGoogle Scholar
  4. 4.
    Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? a propensity score analysis. Ann Thorac Surg. 2009;87:698–703.CrossRefGoogle Scholar
  5. 5.
    Mascherbauer J, Kammerlander AA, Marzluf BA, Graf A, Kocher A, Bonderman D. Prognostic impact of tricuspid regurgitation in patients undergoing aortic valve surgery for aortic stenosis. PLoS One. 2015;10:e0136024.CrossRefGoogle Scholar
  6. 6.
    Varadarajan P, Pai RG. Prognostic implications of tricuspid regurgitation in patients with severe aortic regurgitation: results from a cohort of 756 patients. Interact Cardiovasc Thorac Surg. 2012;14:580–4.CrossRefGoogle Scholar
  7. 7.
    Kalbacher D, Schafer U, von Bardeleben RS, et al. Impact of tricuspid valve regurgitation in surgical high-risk patients undergoing MitraClip implantation: results from the TRAMI registry. EuroIntervention. 2017;12:e1809–16.CrossRefGoogle Scholar
  8. 8.
    Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg. 2006;132:1258–61.CrossRefGoogle Scholar
  9. 9.
    Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRefGoogle Scholar
  10. 10.
    Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.CrossRefGoogle Scholar
  11. 11.
    Ren WJ, Zhang BG, Liu JS, Qian YJ, Guo YQ. Outcomes of tricuspid annuloplasty with and without prosthetic rings: a retrospective follow-up study. J Cardiothorac Surg. 2015;10:81.CrossRefGoogle Scholar
  12. 12.
    Starck CT, Kempfert J, Falk V. Tricuspid valve interventions: surgical techniques and outcomes. EuroIntervention. 2015;11(Suppl W):W128–32.CrossRefGoogle Scholar
  13. 13.
    Rizzoli G, Vendramin I, Nesseris G, Bottio T, Guglielmi C, Schiavon L. Biological or mechanical prostheses in tricuspid position? A meta-analysis of intra-institutional results. Ann Thorac Surg. 2004;77:1607–14.CrossRefGoogle Scholar
  14. 14.
    Badhwar V, Rankin JS, He M, et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg. 2017;103:587–93.CrossRefGoogle Scholar
  15. 15.
    Bernal JM, Morales D, Revuelta C, Llorca J, Gutierrez-Morlote J, Revuelta JM. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg. 2005;130:498–503.CrossRefGoogle Scholar
  16. 16.
    Rodes-Cabau J, Hahn RT, Latib A, et al. Transcatheter therapies for treating tricuspid regurgitation. J Am Coll Cardiol. 2016;67:1829–45.CrossRefGoogle Scholar
  17. 17.
    Praz F, George I, Kodali S, et al. Transcatheter tricuspid valve-in-valve intervention for degenerative bioprosthetic tricuspid valve disease. J Am Soc Echocardiogr. 2018;31:491–504.CrossRefGoogle Scholar
  18. 18.
    Hahn RT. Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design. Ann Cardiothorac Surg. 2017;6:240–7.CrossRefGoogle Scholar
  19. 19.
    Lauten A, Dreger H, Laule M, Stangl K, Figulla HR. Caval valve implantation. Interv Cardiol Clin. 2018;7:57–63.PubMedGoogle Scholar
  20. 20.
    Rosser BA, Taramasso M, Maisano F. Transcatheter interventions for tricuspid regurgitation: TriCinch (4Tech). EuroIntervention. 2016;12:Y110–2.CrossRefGoogle Scholar
  21. 21.
    Hahn RT, Meduri CU, Davidson CJ, et al. Early feasibility study of a transcatheter tricuspid valve annuloplasty: SCOUT trial 30-day results. J Am Coll Cardiol. 2017;69:1795–806.CrossRefGoogle Scholar
  22. 22.
    Besler C, Orban M, Rommel KP, et al. Predictors of procedural and clinical outcomes in patients with symptomatic tricuspid regurgitation undergoing transcatheter edge-to-edge repair. JACC Cardiovasc Interv. 2018;11:1119–28.CrossRefGoogle Scholar
  23. 23.
    Stephan von Bardeleben R, Tamm A, Emrich T, Munzel T, Schulz E. Percutaneous transvenous direct annuloplasty of a human tricuspid valve using the Valtech Cardioband. Eur Heart J. 2017;38:690.CrossRefGoogle Scholar
  24. 24.
    Campelo-Parada F, Perlman G, Philippon F, et al. First-in-man experience of a novel transcatheter repair system for treating severe tricuspid regurgitation. J Am Coll Cardiol. 2015;66:2475–83.CrossRefGoogle Scholar
  25. 25.
    Prihadi EA, Delgado V, Hahn RT, Leipsic J, Min JK, Bax JJ. Imaging needs in novel transcatheter tricuspid valve interventions. JACC Cardiovasc Imaging. 2018;11:736–54.CrossRefGoogle Scholar
  26. 26.
    Ancona F, Agricola E, Stella S, et al. Interventional imaging of the tricuspid valve. Interv Cardiol Clin. 2018;7:13–29.PubMedGoogle Scholar
  27. 27.
    Ancona F, Stella S, Taramasso M, et al. Multimodality imaging of the tricuspid valve with implication for percutaneous repair approaches. Heart. 2017;103:1073–81.CrossRefGoogle Scholar
  28. 28.
    Vismara R, Gelpi G, Prabhu S, et al. Transcatheter edge-to-edge treatment of functional tricuspid regurgitation in an ex vivo pulsatile heart model. J Am Coll Cardiol. 2016;68:1024–33.CrossRefGoogle Scholar
  29. 29.
    Faletra FF, Pedrazzini G, Pasotti E, et al. 3D TEE during catheter-based interventions. JACC Cardiovasc Imaging. 2014;7:292–308.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luigi P. Badano
    • 1
    Email author
  • Arnaldo Rabischoffsky
    • 2
  • Marco Previtero
    • 3
  • Roberto Carlos Ochoa-Jimenez
    • 4
  1. 1.University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca HospitalMilanoItaly
  2. 2.Department of EchocardiographyPro Cardiaco HospitalRio de JaneiroBrazil
  3. 3.Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua School of MedicinePaduaItaly
  4. 4.Department of Internal MedicineMount Sinai St Luke and Mount Sinai WestNew YorkUSA

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