Flattening The Saddle: Minimum Intensity Projection Overcomes Saddle-shaped Distortions In Tricuspid Annular Sizing For Transcatheter Tricuspid Valve Replacement
Recommended Citation
Alter J, Fram G, Dawdy J, Alrayes H, Kar Lok Lai L, Saleem M, Obeidat L, Mohammed M, Parikh S, Zweig B, Kar Lok Lai L, Song T, Pantelic M, Bowerman N, Villablanca P, Engel Gonzalez P, Frisoli T, O'Neill BP, Lee JC. Flattening The Saddle: Minimum Intensity Projection Overcomes Saddle-shaped Distortions In Tricuspid Annular Sizing For Transcatheter Tricuspid Valve Replacement. J Cardiovasc Comput Tomogr 2025; 19(4):S97.
Document Type
Conference Proceeding
Publication Date
7-1-2025
Publication Title
J Cardiovasc Comput Tomogr
Abstract
Introduction: Transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment for severe tricuspid regurgitation. Accurate preprocedural assessment of the tricuspid annulus is critical for successful device sizing and deployment. However, the saddle-shaped geometry of the annulus introduces variability in simple planar measurements derived from standard multiplanar reformatted (MPR) images. Dedicated tricuspid annular postprocessing software can account for the saddle shape but typically requires significant and ongoing licensing costs. Minimum intensity projection (minIP) imaging is a standard 3D workstation feature which can provide a virtual flattening of the annular saddle minimizing the impact of annular distortions, without incurring additional expense. Methods: A total of 72 patients who underwent ECG-gated CT angiography (CTA) for preprocedural TTVR planning were evaluated. The imaging planers were aligned to the tricuspid annulus using standard 3D MPR techniques. Additional reconstructions were performed with a minIP reconstruction technique at an increased slide thickness of approximately 10-15 mm. Annular areas and dimensions measured on MPR and minIP reconstructions and compared to vendor-supplied annular reference values from dedicated postprocessing software. Analyses performed using adjusted R2 correlation. Results: MinIP-derived annular measurements demonstrated superior correlation with vendor-supplied reference values compared to MPR: minIP (AdjR2 = 0.91) vs. MPR (AdjR2 = 0.87). This correlation persisted when vendor-supplied maximum annular dimensions were correlated to minIP and MPR maximum annular dimensions: minIP (AdjR2 = 0.90) vs. MPR (AdjR2 = 0.83). When comparing vendor-supplied minimum annular dimension there was no difference between minIP and MPR minimum annular dimensions (AdjR2 = 0.83 each). Conclusions: MinIP derived tricuspid annular measurements have better correlation with vendor supplied measurements, driven by less overestimation of maximum annular dimensions. The effect is likely related to mitigation of saddle-shaped distortion allowing for a more planar measurement. This technique offers a practical and cost-efficient alternative for centers without access to dedicated tricuspid annulus analysis software. By reducing measurement variability, minIP may enhance prosthesis selection and optimize procedural outcomes for TTVR. Future direction is needed to determine specific impact on valve sizing. [Formula presented]
Volume
19
Issue
4
First Page
S97
