https://orcid.org/0000-0002-6066-3872
A 77-year-old woman, with atrial fibrillation and history of stroke, presented with symptomatic torrential tricuspid regurgitation (TR). Echocardiogram and right heart catheterization confirmed severe TR with slightly elevated pulmonary artery pressure. Surgical risk was considered high (Society of Thoracic Surgery score 7.21%) and was not a good candidate for other percutaneous tricuspid repair techniques. Based on multislice computed tomography (MSCT)-fluoroscopy fusion imaging (HeartNavigator system; Philips Healthcare), two self-expanding percutaneous heart valves were custom-made with 10–20% oversizing to fit the anticipated implantation site in the superior vein cave (SVC) and inferior vein cave (IVC). The IVC valve was designed with the upper segment protruding into the right atrium with the biological valve located above the diaphragm to protect the abdominal vasculature from systolic backflow and avoid occlusion of hepatic veins. For the SVC valve, the stent frame was funnel shaped with the upper and lower segments tapered to facilitate sufficient fixation at the cavo-atrial inflow.
To the best of our knowledge, the use of MSCT-fluoroscopy fusion imaging to facilitate the implantation of the percutaneous bicaval devices for the treatment of TR has not been previously reported. MSCT-fluoroscopy fusion imaging is a useful tool for assessment of eligibility for percutaneous bicaval valve implantation and to determine the optimal site. It provides an interesting tool for procedural planning and guidance. (Panel A) TR in transoesophageal echocardiogram; (Panel B) MSCT-fluoroscopy fusion imaging (initial view); (Panel C) SVC implantation; (Panel D) angiogram (final); (Panel E) transoesophageal echocardiogram (final) (Panel F) MSCT-fluoroscopy fusion imaging (final).
