Lauren S Ranard1, Torsten P Vahl1,2, Christine J Chung3, Shirin Sadri1, Omar K Khalique1,2, Nadira Hamid1,2, Tamim Nazif1,2, Isaac George1, Vivian Ng1, Amisha Patel1, Carolina P Rezende1, Mark Reisman4, Azeem Latib5, Jörg Hausleiter6, Paul Sorajja7, Vinayak N Bapat7, Gilbert H L Tang8, Charles J Davidson9, Firas Zahr10, Raj Makkar11, Neil P Fam12, Juan F Granada2, Martin B Leon1,2, Rebecca T Hahn1,2, Susheel Kodali1,2. 1. Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA. 2. Cardiovascular Research Foundation, New York, New York, USA. 3. Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA. 4. Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA. 5. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. 6. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. 7. Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. 8. Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA. 9. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 10. Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. 11. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 12. Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Abstract
OBJECTIVES: The purpose of this study was to characterize the anatomic relationship between the inferior vena cava (IVC) and tricuspid annulus (TA) and its potential impact on the performance of transcatheter TV interventions. BACKGROUND: Transcatheter tricuspid valve (TV) interventions are emerging as a therapeutic alternative for the treatment of severe, symptomatic tricuspid regurgitation (TR). Progression of TR is associated with right heart dilatation. These anatomic changes may distort the IVC-TA relationship and impact successful implantation of transcatheter devices. METHODS: Fifty patients who presented with symptomatic TR for consideration of transcatheter TV therapy with an available CT were included in the study. Comprehensive transesophageal echocardiogram and CT analyses were performed to assess the right-sided cardiac chambers, TA and IVC-TA relationship. RESULTS: The mean age of the study cohort was 78.4 ± 8.9 years. Torrential TR was present in 54% (n = 27). There was considerable variation in the short axis mid-IVC to mid-TA offset (SAXMID 18.2 ± 7.9 mm, range 4.7-42.1 mm). CONCLUSIONS: The IVC-to-TA relationship exhibits significant variability in patients with symptomatic TR. CT analysis of the tricuspid anatomy, including the relationship to the surrounding structures and the IVC, is essential for planning transcatheter TV interventions. Further studies are needed to define whether the IVC-to-TA relationship is a predictor of technical success in the context of specific transcatheter delivery systems.
OBJECTIVES: The purpose of this study was to characterize the anatomic relationship between the inferior vena cava (IVC) and tricuspid annulus (TA) and its potential impact on the performance of transcatheter TV interventions. BACKGROUND: Transcatheter tricuspid valve (TV) interventions are emerging as a therapeutic alternative for the treatment of severe, symptomatic tricuspid regurgitation (TR). Progression of TR is associated with right heart dilatation. These anatomic changes may distort the IVC-TA relationship and impact successful implantation of transcatheter devices. METHODS: Fifty patients who presented with symptomatic TR for consideration of transcatheter TV therapy with an available CT were included in the study. Comprehensive transesophageal echocardiogram and CT analyses were performed to assess the right-sided cardiac chambers, TA and IVC-TA relationship. RESULTS: The mean age of the study cohort was 78.4 ± 8.9 years. Torrential TR was present in 54% (n = 27). There was considerable variation in the short axis mid-IVC to mid-TA offset (SAXMID 18.2 ± 7.9 mm, range 4.7-42.1 mm). CONCLUSIONS: The IVC-to-TA relationship exhibits significant variability in patients with symptomatic TR. CT analysis of the tricuspid anatomy, including the relationship to the surrounding structures and the IVC, is essential for planning transcatheter TV interventions. Further studies are needed to define whether the IVC-to-TA relationship is a predictor of technical success in the context of specific transcatheter delivery systems.
Authors: Valeria Cammalleri; Myriam Carpenito; Domenico De Stefano; Gian Paolo Ussia; Maria Caterina Bono; Simona Mega; Annunziata Nusca; Nino Cocco; Edoardo Nobile; Aurelio De Filippis; Luka Vitez; Carlo Cosimo Quattrocchi; Francesco Grigioni Journal: J Clin Med Date: 2022-05-17 Impact factor: 4.964