Mazzola Matteo, Giannini Cristina, Sticchi Alessandro, Spontoni Paolo, Pugliese Nicola Riccardo, Gargani Luna, De Carlo Marco
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Paradisa, 2, 56124 Pisa, Italy.
Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, via Paradisa, 2, 56124 Pisa, Italy.
Eur Heart J Imaging Methods Pract. 2024 Mar 21;2(1):qyae017. doi: 10.1093/ehjimp/qyae017. eCollection 2024 Jan.
Tricuspid regurgitation (TR) carries an unfavourable prognosis and often leads to progressive right ventricular (RV) failure. Secondary TR accounts for over 90% of cases and is caused by RV and/or tricuspid annulus dilation, in the setting of left heart disease or pulmonary hypertension. Surgical treatment for isolated TR entails a high operative risk and is seldom performed. Recently, transcatheter edge-to-edge repair (TEER) has emerged as a low-risk alternative treatment in selected patients. Although the experience gained from mitral TEER has paved the way for the technique's adaptation to the tricuspid valve (TV), its anatomical complexity necessitates precise imaging. To this end, a comprehensive protocol integrating 2D and 3D imaging from both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) plays a crucial role. TTE allows for an initial morphological assessment of the TV, quantification of TR severity, evaluation of biventricular function, and non-invasive haemodynamic evaluation of pulmonary circulation. TOE, conversely, provides a detailed evaluation of TV morphology, enabling precise assessment of TR mechanism and severity, and represents the primary method for determining eligibility for TEER. Once a patient is considered eligible for TEER, TOE, alongside fluoroscopy, will guide the procedure in the catheterization lab. High-quality TOE imaging is crucial for patient selection and to achieve procedural success. The present review examines the roles of TTE and TOE in managing patients with severe TR eligible for TEER, proposing the step-by-step protocol successfully adopted in our centre.
三尖瓣反流（TR）预后不良，常导致进行性右心室（RV）衰竭。继发性TR占病例的90%以上，由左心疾病或肺动脉高压情况下的RV和/或三尖瓣环扩张引起。孤立性TR的外科治疗手术风险高，很少进行。最近，经导管缘对缘修复（TEER）已成为部分患者的低风险替代治疗方法。尽管二尖瓣TEER积累的经验为该技术应用于三尖瓣（TV）铺平了道路，但其解剖结构复杂，需要精确成像。为此，整合经胸超声心动图（TTE）和经食管超声心动图（TOE）的二维和三维成像的综合方案起着关键作用。TTE可对TV进行初步形态学评估、量化TR严重程度、评估双心室功能以及对肺循环进行无创血流动力学评估。相反，TOE可对TV形态进行详细评估，从而精确评估TR机制和严重程度，是确定TEER适应证的主要方法。一旦患者被认为适合TEER，TOE将与荧光透视一起在导管室指导手术。高质量的TOE成像对于患者选择和手术成功至关重要。本综述探讨了TTE和TOE在管理适合TEER的严重TR患者中的作用，并提出了我们中心成功采用的分步方案。
