Cardiac Computed Tomography To Predict Transesophageal Echocardiographic Acoustic Windows In Transcatheter Tricuspid Valve Replacement

Document Type

Conference Proceeding

Publication Date

7-1-2025

Publication Title

J Cardiovasc Comput Tomogr

Abstract

Introduction: Transcatheter tricuspid valve replacement (TTVR) with the Evoque valve (Edwards Lifesciences, USA) is a highly complex procedure, requiring meticulous interrogation of nine anchors of the valve to ensure adequate capture within the native leaflets of the tricuspid valve. Procedural success is highly dependent on excellent fidelity on transesophageal echocardiogram (TEE) to guide the procedure. Methods: A retrospective analysis was conducted on 36 patients who underwent commercial TTVR at a single-center. All patients had pre-procedural CCT analysis done for planning purposes. Patient baseline TEE imaging was separately and blindly retrospectively reviewed by two cardiac imaging specialists and adjudicated image quality on a 5-point Likert scale. Images graded at multiple views and pooled grading of the mid-esophageal TEE windows was classified as either “high-quality” or “low-quality”, depending on ability to view tricuspid leaflets in systole, diastole, and three-dimensional multi-planar reformatting. CCT images were analyzed for hypothesized predictors of TEE imaging quality, including distance from esophagus to tricuspid valve (TV), distance from stomach to TV, right atrial height, and intra-atrial septal thickness. Results: After TEE adjudication, 13 patients were deemed to have low-quality TEE acoustic windows, and 26 were deemed to have high-quality acoustic windows. Amongst the analysis of CCT measurements, trends are shown in figure 1. The strongest trend predicting high quality TEE imaging was an increasing distance from stomach to right ventricle (AdjR2 = 0.15). Increasing septal thickness (AdjR2 = 0.03), increasing right atrial height (AdjR2 = 0.03), and increasing distance from esophagus to right ventricle (AdjR2 = 0.01) did not have any strong correlation with acoustic windows on TEE. Conclusions: TTVR relies on skilled specialists from both a procedural and imaging perspective. Utilization of pre-procedural CCT to predict intra-procedural TEE quality may assist procedure planning, such as anticipating need for access to deploy adjunctive imaging modalities such as intra-cardiac echocardiography. We did not identify a strong correlation of CT imaging with TEE image quality, although early trends suggest that larger studies may provide improved delineation. [Formula presented]

Volume

19

Issue

4

First Page

S26

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