From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.).
Radiographics. 2023 Jul;43(7):e220153. doi: 10.1148/rg.220153.
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
经导管三尖瓣介入治疗（TTVI）包括多种基于导管的介入技术，用于治疗手术风险高的患者和先前手术失败的患者的三尖瓣反流（TR）。目前有几种作用机制不同的 TTVI 器械正在使用或处于临床前评估阶段。超声心动图是评估三尖瓣疾病的首选方式，可提供三尖瓣形态、TR 机制和血流动力学的信息。心脏 CT 和 MRI 具有许多优势，可用于全面的术前评估。CT 和 MRI 提供了与超声心动图互补的 TR 机制和病因信息。MRI 可使用二维或四维流序列的间接或直接技术来定量 TR 的严重程度。MRI 和 CT 还可以准确地量化右心室容积和功能，这对干预时机至关重要。CT 提供了关于瓣膜、瓣环、瓣下装置和相邻结构形态的全面三维信息。CT 是评估几种特定器械测量值的首选方法，包括三尖瓣环尺寸、瓣环至右冠状动脉距离、瓣叶形态、对合间隙、腔静脉尺寸和腔静脉至肝静脉距离。CT 可评估血管通路以及最佳的透视角度和导管轨迹。术后 CT 和 MRI 可用于检测瓣周漏、假性动脉瘤、血栓、瓣周赘生物、感染性心内膜炎和器械移位等并发症。RSNA，2023 本文的问答测验可在补充材料中找到。
