Echocardiography–computed tomography fusion imaging for guidance of transcatheter tricuspid valve annuloplasty
Federico Fortuni, A Marques, Jeroen J. Bax, Nina Ajmone Marsan, Victoria Delgado
Abstract
Pre-procedural planning of transcatheter tricuspid valve (TV) annuloplasty with the Cardioband tricuspid system® (Edwards Lifesciences) requires the combination of transoesophageal echocardiography (TOE) to assess the severity and mechanism of tricuspid regurgitation and multi-detector row computed tomography (MDCT) to size the TV annulus and its spatial relationship with the right coronary artery (RCA). Using specific software (3mensio, Pie Medical Imaging BV), the direction of the anchors of the Cardioband screwed in the TV annulus can be anticipated and the distance to the RCA can be measured. The procedure is guided with 3D TOE and fluoroscopy. Computed tomography (CT) fusion® (GE Healthcare) integrates 3D TOE data and MDCT (Panels A–C) allowing simultaneous visualization of the TV annulus, the course of the RCA, and the ideal position of the screws. During the procedure, the fluoroscopy imaging can be compared live with the fusion of live 3D TOE and the pre-planning MDCT data (Panels D–H, Supplementary data online, Video S1). These advances can help in the understanding of the TV complex and surrounding structures and communication during the procedure.