key: cord-0814973-r7ibxboh
authors: Wild, Mirjam G.; Gloeckler, Martin; Wustmann, Kerstin B.; Erne, Sophie A.; Grogg, Hanna; Huber, Adrian T.; Windecker, Stephan; Praz, Fabien; Gräni, Christoph
title: Multimodality Imaging for Evaluation of Bicaval Valved Stent Implantation in Severe Tricuspid Regurgitation
date: 2021-10-06
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.07.009
sha: 5930377aa83167f38b15b4000055a5418eb9dffe
doc_id: 814973
cord_uid: r7ibxboh

Preprocedural planning and postprocedural evaluation after transcatheter treatment of severe tricuspid regurgitation remain challenging and require further research and standardization. We illustrate the use of multimodality imaging techniques in 3 patients undergoing implantation of a novel custom-made bicaval valved stent for symptomatic treatment of severe tricuspid regurgitation. (Level of Difficulty: Advanced.)

To define the crucial role of standardized preprocedural and postprocedural multimodality imaging and its synergistic value for novel tricuspid valve devices. To demonstrate the advantages of 4D CT for the assessment of device success and detection of potential device malfunction. To appreciate the necessity of collaboration among interventional cardiologists, imaging specialists, and engineers to develop and evaluate novel and innovative valve therapies.

An 82-year-old female patient was referred for evaluation of treatment options for symptomatic massive TR (Video 1A). She was symptomatic with dyspnea at rest (New York Heart Association [NYHA] functional class IV), she required home oxygen, and she had pronounced anasarca, pleural effusions, ascites, and loss of appetite, despite maximal diuretic therapy.

Multimodality imaging was used to assess her eligibility for bicaval stent implantation (Tables 1 and 2, Table 2) .

A 79-year-old female patient had previously been hospitalized for RV failure. She had severe heart failure symptoms, including dyspnea (NYHA functional class III), peripheral edema, pleural effusions ( Figure 3A) , ascites, chronic renal failure, and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) ( Table 2) Multimodality Imaging for Bicaval Valved Stent Implantation Clinical and echocardiographic follow-up reported after 2 and 3 months, respectively. CMR and CT follow-up reported after the given time period (days).

CMR ¼ cardiac magnetic resonance; CT ¼ computed tomography; EDA ¼ end-diastolic area; ESA ¼ end-systolic area; FAC ¼ fractional area change; GCS ¼ global peak systolic circumferential strain; GFR ¼ glomerular filtration rate; GLS ¼ global peak systolic longitudinal strain; GRS ¼ global peak systolic radial strain; LV ¼ left ventricular; NT-proBNP ¼ N-terminal pro-B-type natriuretic peptide; NYHA ¼ New York Heart Association; RV ¼ right ventricular; RVEDV ¼ right ventricular end-diastolic volume; RVEF ¼ right ventricular ejection fraction; sPAP ¼ systolic pulmonary artery pressure; TAPSE ¼ tricuspid annular plane systolic excursion; TR ¼ tricuspid regurgitation. (Figures 5A and 5B) . This postprocessing analysis confirmed that the segments of the stent exposed to the greatest physical stress were those located on the opposite site of the valve. We were able to show that 4D CT allows not only anatomical evaluation, but also assessment @chrisgraeni.

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