Bax, J.J.

Chimed, S.

Delgado, V.

Fortuni, F.

Hirasawa, K.

Lustosa, R.

Marques, A.I.

Marsan, N.A.

Pio, S.M.

Tjahjadi, C.

Wang, X.

Leiden University Scholary Publications

Computed tomography-derived transesophageal echocardiographic viewsstep forward for procedural planning of transcatheter tricuspid valveannuloplastyFortuni, F.; Hirasawa, K.; Marques, A.I.; Pio, S.M.; Chimed, S.; Lustosa, R.; ... ; Delgado, V.CitationFortuni, F., Hirasawa, K., Marques, A. I., Pio, S. M., Chimed, S., Lustosa, R., … Delgado, V.(2021). Computed tomography-derived transesophageal echocardiographic views step forwardfor procedural planning of transcatheter tricuspid valve annuloplasty. Circulation: CardiovascularImaging, 14(1), 114-117. doi:10.1161/CIRCIMAGING.120.011107 Version: Publisher's VersionLicense: Creative Commons CC BY 4.0 licenseDownloaded from: https://hdl.handle.net/1887/3279651 Note: To cite this publication please use the final published version (if applicable).Circ Cardiovasc Imaging. 2021;14:e011107. DOI: 10.1161/CIRCIMAGING.120.011107 January 2021 114Federico Fortuni, MDKensuke Hirasawa , MD, PhDAna I. Marques , MDStephan M. Pio, MDSurenjav Chimed, MDRodolfo Lustosa, MDCatherina Tjahjadi, MDXu Wang, MDJeroen J. Bax, MD, PhDNina Ajmone Marsan, MD, PhDVictoria Delgado , MD, PhDTransthoracic and transesophageal echocardiography (TEE) and multidetec-tor row computed tomography (MDCT) are pivotal in the selection of pa-tients and preprocedural planning of transcatheter valvular interventions.1–3 For transcatheter tricuspid valve (TV) annuloplasty with the Cardioband system (Edwards Lifesciences, Irvine, CA), high spatial resolution data acquired with MDCT permit accurate measurement of the dimensions of the TV annulus to se-lect the device size and assessment of the distance between the TV annulus and the right coronary artery (Figure 1).1 Echocardiography is the mainstay imaging modality to grade tricuspid regurgitation severity and to assess its mechanism. To guide the procedure, TEE and fluoroscopy are the imaging techniques of choice. However, TEE has lower spatial resolution compared with MDCT and does not allow to identify the course of the right coronary artery along the TV annulus. Furthermore, considered the relative far position of the TV from the TEE probe, in most patients it might be difficult to image the location where the anchors of the Cardioband system should be placed. A dedicated software (3mensio, Pie Medi-cal Imaging BV) for post-processing MDCT data permits to reproduce TEE views, which may be compared with the TEE images during the intervention. This novel tool may facilitate preprocedural planning and also the communication between interventionalists and imagers. Specifically, for transcatheter TV annuloplasty, it may help to better understand the individual anatomy of the TV annulus and al-lows to place the anchors of the device and identify the best TEE views to guide the procedure (Figure 2 and Video 1 in the Data Supplement).We present a case of a 78-year-old patient with residual severe secondary tricuspid regurgitation after transcatheter edge-to-edge TV repair and New York Heart Association class III heart failure symptoms who underwent transcatheter TV annuloplasty because of high operative risk. In the preoperative TEE evalu-ation, the imaging of the anterior portion of the TV annulus was particularly challenging. The MDCT-derived TEE views were determinant in identifying the best TEE probe position and angulation to visualize the predicted location of the anchors (Figure 3A and 3B). The procedure was successful with a significant reduction of the annular diameter and tricuspid regurgitation grade (Figure 3C) that was accompanied by an improvement in heart failure symptoms 1 month after the procedure. ARTICLE INFORMATIONThe Data Supplement is available at https://www.ahajournals.org/doi/suppl/ 10.1161/CIRCIMAGING.120.011107.CorrespondenceVictoria Delgado, MD, Department of Cardiology, Heart Lung Center, Albinusdreef 2 2300 RC Leiden, the Nether-lands. Email v.delgado@lumc.nl© 2021 American Heart Association, Inc.CARDIOVASCULAR IMAGESComputed Tomography-Derived Transesophageal Echocardiographic ViewsStep Forward for Procedural Planning of Transcatheter Tricuspid Valve AnnuloplastyCirculation: Cardiovascular Imaginghttps://www.ahajournals.org/journal/circimagingKey Words: echocardiography  ◼ fluoroscopy ◼ multidetector computed tomography ◼ tricuspid valveDownloaded from http://ahajournals.org by on March 17, 2022Circ Cardiovasc Imaging. 2021;14:e011107. DOI: 10.1161/CIRCIMAGING.120.011107 January 2021 115Fortuni et al; CT-Derived TEE Views for TTVTAffiliationsDepartment of Cardiology, Leiden University Medical Center, The Nether-lands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.). Depart-ment of Molecular Medicine, Unit of Cardiology, University of Pavia, Italy (F.F.). Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal (A.I.M.).Sources of FundingNone.DisclosuresDr Lustosa received funding from the European Society of Cardiology in form of an ESC Research Grant. The reference of application number is R-2018-17759. Dr Pio received funding from the European Society of Cardiology in form of an ESC Training Grant. The reference of application number is T-2018-17405. The Department of Cardiology of the Leiden University Medical Center received research grants from Abbott Vascular, Bioventrix, Medtronic, Biotronik, Boston Scientific, GE Healthcare and Edwards Lifesciences. Drs Bax and Ajmone Mar-san received speaking fees from Abbott Vascular. Dr Delgado received speaker fees from Abbott Vascular, Medtronic, MSD, Edwards Lifesciences, and GE Healthcare. The other authors report no conflicts.REFERENCES 1. Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac computed tomography and magnetic resonance imaging in the evaluation of mitral and tricuspid valve disease: implications for transcatheter interventions. Circ Cardiovasc Imaging. 2017;10:e005331. doi: 10.1161/CIRCIMAGING.116.005331 2. Hahn RT. State-of-the-art review of echocardiographic imaging in the eval-uation and treatment of functional tricuspid regurgitation. Circ Cardiovasc Imaging. 2016;9:e005332. doi: 10.1161/CIRCIMAGING.116.005332 3. Dulgheru R, Pibarot P, Sengupta PP, Piérard LA, Rosenhek R, Magne J, Donal E, Bernard A, Fattouch K, Cosyns B, et al. Multimodality imaging strategies for the assessment of aortic stenosis: viewpoint of the Heart Valve Clinic International Database (HAVEC) Group. Circ Cardiovasc Imag-ing. 2016;9:e004352. doi: 10.1161/CIRCIMAGING.115.004352Figure 1. Key steps for preprocedural planning of transcatheter tricuspid valve (TV) annuloplasty.A, A multidetector row computed tomography view of the TV plane. The TV annulus (red circle) and the right coronary artery (green line) can be manually defined to predict the best location for the anchors of the Cardioband system (A1–A17). The plane to best visualize the TV can be adjusted on the corresponding sagittal view (B). C, Displays a predicted left anterior oblique (LAO) fluoroscopic view with the structures that have been previously defined and that corresponds well to the intraprocedural fluoroscopic view (D), where the right coronary artery (green arrow), anchors (yellow arrow), and delivery system (white arrow) can be identi-fied. Ao indicates aorta; CAU, caudal; CRA, cranial; LV, left ventricle; MPR, multiplanar reconstruction; RA, right atrium; and RV, right ventricle.Downloaded from http://ahajournals.org by on March 17, 2022Circ Cardiovasc Imaging. 2021;14:e011107. DOI: 10.1161/CIRCIMAGING.120.011107 January 2021 116Fortuni et al; CT-Derived TEE Views for TTVTFigure 2. Computed tomography-derived transesophageal echocardiography (TEE) views for preprocedural planning of transcatheter tricuspid valve (TV) annuloplasty.The software for postprocessing multidetector row computed tomography (MDCT) data permit to trace the TV annulus (yellow arrow), right coronary artery, predict the position of the anchors (A1–A17) of the Cardioband system, and identify the best TEE views to image them. A, Shows the mid-esophageal 4-chamber MDCT-derived TEE view focused on the right chambers. The cursor may be placed across the TV to obtain an orthogonal view to display a modified mid-esoph-ageal bicaval view of the TV (B). C, Shows the 3-dimensional rendering of the heart with the TEE probe (white arrow) located posteriorly at the mid-esophageal level, while (D) shows the predicted position of the TEE probe on the fluoroscopic projection during the procedure. A indicates anchor; Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RAO, right anterior oblique; and RV, right ventricle.Downloaded from http://ahajournals.org by on March 17, 2022Circ Cardiovasc Imaging. 2021;14:e011107. DOI: 10.1161/CIRCIMAGING.120.011107 January 2021 117Fortuni et al; CT-Derived TEE Views for TTVTFigure 3. Computed tomography-derived transesophageal echocardiography (TEE) views to guide transcatheter tricuspid valve (TV) annuloplasty.The software allows to postprocess multidetector row computed tomography data (A), place the virtual TEE probe (white arrow), and adjust the settings to derive the best TEE view to image the location where the anchors should be placed. B, Shows the corresponding intraprocedural fluoroscopic and TEE views where the catheter (yellow arrow) approaching the TV annulus to place one of the first anchors can be identified. C, Demonstrates the reduction of tricuspid regurgitation grade from severe (upper image) to moderate (lower image) after successful transcatheter TV annuloplasty. AoV indicates aortic valve; LA, left atrium; LCC, left coronary cusp; NCC, noncoronary cusp; RA, right atrium; RCC, right coronary cusp; and RV, right ventricle.Downloaded from http://ahajournals.org by on March 17, 2022

Computed tomography-derived transesophageal echocardiographic views step forward for procedural planning of transcatheter tricuspid valve annuloplasty

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Computed tomography-derived transesophageal echocardiographic views step forward for procedural planning of transcatheter tricuspid valve annuloplasty

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