Extract

Multimodality imaging represents an essential tool in transcatheter tricuspid valve (TV) therapies. A combination of Computed tomography (CT)-Scan, echocardiography and fluoroscopy, is used for planning and intra-procedural guidance. The understanding of anatomy through the different imaging modalities is challenging and not standardized yet. However, their interpretation is fundamental to navigate in the right atrium towards the desired therapeutic target.

We here show an example of comparative anatomy of the TV with different imaging modalities in a patient who underwent direct tricuspid annuloplasty with the CardioBand (ValtechCardio, OrYehuda, Israel) device.

Panel A resumes anatomical findings in short axis transgastric view using 2D transesophageal echocardiography. The identification of aortic valve is the first step to understand the leaflet orientation: opposite to the aortic valve (AV) (that in this case is easily identified by a previous surgically implanted bioprosthesis), there is the posterior tricuspid leaflet (P). Going counterclokwise, respectively septal (S) and anterior (A) can be identified.

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