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Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank–Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR. [ABSTRACT FROM AUTHOR]

Background: Permanent pacing is often required following valve intervention (either surgical or percutaneous); however, tricuspid interventions pose specific challenges to conventional pacing. Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention. Purpose: To report periprocedural outcomes and follow-up of patients undergoing implantation of a LP system following tricuspid valve interventions. Methods: Patients with previous tricuspid valve intervention at the time of attempted implantation of a LP (MicraTM, Medtronic, Minneapolis, MN, USA) were included. Results: Between 2019 and 2022, 40 patients underwent LP implantations following tricuspid interventions in 5 large tertiary centers. The mean age was 68.9 ± 13.7 years, and 48% patients were male. The indication for pacing was as following: AVB in 27 (68%) patients, AF with slow ventricular response in 10 (25%) patients, and refractory rapid atrial fibrillation (AF) referred to AV junction ablation in 3 (7%) patients. Most of the patients received Micra VR (78%). The procedure was successful in all patients. The mean procedural time is 58 ± 32 min, and the median fluoroscopy time is 7.5 min. Electrical parameters were within normal range (threshold: 1.35 ± 1.2 V@0.24 ms, impedance: 772 ± 245 Ohm, R-wave: 6.9 ± 5.4 mV). No acute complications were observed. During a mean follow-up of 10 months, electrical parameters remained stable, and 4 deaths were occurred (not related to the procedure). Conclusion: A LP is a safe and efficient option following tricuspid valve interventions. [ABSTRACT FROM AUTHOR]

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In the pediatric and congenital heart disease (CHD) population, tricuspid valve (TV) disorders are complex due to the variable TV morphology, its sophisticated interaction with the right ventricle as well as associated congenital and acquired lesions. While surgery is the standard of care for TV dysfunction in this patient population, transcatheter treatment for bioprosthetic TV dysfunction has been performed successfully. Detailed and accurate anatomic assessment of the abnormal TV is essential in the preoperative/preprocedural planning. Three-dimensional transthoracic and 3D transesophageal echocardiography (3DTEE) provides added value to 2-dimensional imaging in the characterization of the TV to guide therapy and 3DTEE serves as an excellent tool for intraoperative assessment and procedural guidance of transcatheter treatment. Notwithstanding advances in imaging and therapy, the timing and indication for intervention for TV disorders in this population are not well defined. In this manuscript, we aim to review the available literature, provide our institutional experience with 3DTEE, and briefly discuss the perceived challenges and future directions in the assessment, surgical planning, and procedural guidance of (1) congenital TV malformations, (2) acquired TV dysfunction from transvenous pacing leads, or following cardiac surgeries, and (3) bioprosthetic TV dysfunction. [ABSTRACT FROM AUTHOR]

Tricuspid valve disease represents a major health problem that affects a wide proportion of heart failure patients with a significant prognostic impact. In recent years an increasing number of minimally invasive and transcatheter treatments have been developed. The choice of the optimal transcatheter device therapy needs a careful patient selection and a dedicated anatomic assessment, mainly based on echocardiographic and computed tomography evaluation. Moreover, cardiac magnetic resonance has an established role in the functional assessment of right heart chambers with relevant prognostic implications. In this review we describe the role of multimodality imaging in the tricuspid valve disease assessment with an intervention-oriented perspective, from the pre-operative planning for different devices to the intraprocedural guide during transcatheter edge-to-edge repair. [ABSTRACT FROM AUTHOR]

Isolated tricuspid regurgitation is an egregious finding in patients with valvular disease( Rana and et al., 1 Feb. 2019) .11 Severe tricuspid regurgitation has been associated with hepatic congestion and can progress to hepatic cirrhosis( Rana and et al., 1 Feb. 2019; Fender et al., 2018) .1,21,2 However, isolated tricuspid valve surgery is done occasionally and is associated with the highest mortality among all valve interventions( Baumgartner et al., 2017) .33 Options for percutaneous interventions are still at an nascent/investigational stage. We report one such successful tricuspid valve intervention..

We evaluated early outcomes of transcatheter valve‐in‐valve (ViV) implantation in patients with degenerated bio‐prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up. [ABSTRACT FROM AUTHOR]

Abstract We evaluated early outcomes of transcatheter valve‐in‐valve (ViV) implantation in patients with degenerated bio‐prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up.

Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps.

Tricuspid valve disease represents a major health problem that affects a wide proportion of heart failure patients with a significant prognostic impact. In recent years an increasing number of minimally invasive and transcatheter treatments have been developed. The choice of the optimal transcatheter device therapy needs a careful patient selection and a dedicated anatomic assessment, mainly based on echocardiographic and computed tomography evaluation. Moreover, cardiac magnetic resonance has an established role in the functional assessment of right heart chambers with relevant prognostic implications. In this review we describe the role of multimodality imaging in the tricuspid valve disease assessment with an intervention-oriented perspective, from the pre-operative planning for different devices to the intraprocedural guide during transcatheter edge-to-edge repair.

Primary or secondary tricuspid regurgitation (TR) represents an important health care burden and challenge which has often been neglected or undertreated in the past. The expansion and reinforcement of the indications for tricuspid valve (TV) intervention in the 2017 editions of the guidelines as well as the introduction of transcatheter tricuspid valve intervention (TTVI) has considerably increased the attention of the community on the TV and the volume of TV interventions in the past years. Depending on the anatomic target, TTVI can be categorized as the following: 1) direct or indirect tricuspid restrictive annuloplasty; 2) direct (edge-to-edge repair) or indirect (coaptation device) restoration of leaflet coaptation; 3) heterotopic tricuspid valve implantation; and 4) transcatheter tricuspid valve replacement. Multimodality imaging has crucial role for the following: 1) patient selection for TTVI and procedure planning; 2) guiding and monitoring the procedure; and 3) assessing and following over time the results of the procedure. The key points for pre-procedural imaging are: 1) accurate quantitation of TR severity; 2) proper identification of the mechanism(s) responsible for the TR; and 3) quantitation of RV dysfunction and pulmonary arterial hypertension. This imaging work-up is essential to select the right type of intervention for the right patient and TV. Transesophageal echocardiography and fluoroscopy imaging is also key for guiding the TTVI procedures and fusion between these 2 modalities may further enhance the quality of procedure guiding. • The volume of surgical and transcatheter valve interventions has increased in the past years. • Multimodality imaging is essential for assessing patient's eligibility for TV intervention, guiding procedure, and assessing outcomes. • Key points for preprocedural imaging of TV intervention are accurate quantitation of TR severity, identification of TR mechanisms, and quantitation of RV dysfunction. • TEE and cinefluoroscopy are keys for guiding the TV interventions. • Fusion imaging and 3D TEE are helpful for more complex TV procedures such as TriClip and transcatheter annuloplasty. [ABSTRACT FROM AUTHOR]

Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps.