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Multimodality imaging of the tricuspid valve with implication for percutaneous repair approaches
  1. Francesco Ancona1,
  2. Stefano Stella1,
  3. Maurizio Taramasso2,
  4. Claudia Marini1,
  5. Azeem Latib3,
  6. Paolo Denti4,
  7. Francesco Grigioni5,
  8. Maurice Enriquez-Sarano6,
  9. Ottavio Alfieri4,
  10. Antonio Colombo3,
  11. Francesco Maisano2,
  12. Eustachio Agricola1
  1. 1 Echocardiography Laboratory, San Raffaele Scientific Institute, Milan, Italy
  2. 2 Heart Valve Clinic, UniversitätsSpital Zürich, University of Zürich, Zürich, Switzerland
  3. 3 Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
  4. 4 Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
  5. 5 Cardiology Unit, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
  6. 6 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Francesco Ancona, Echocardiography Laboratory, San Raffaele Scientific Hospital, Via Olgettina 60, Milano 20132, Italy; ancona.francesco{at}


Nowadays some percutaneous options for tricuspid valve (TV) repair are available: Tricinch (4Tech Cardio, Galway, Ireland) mimicking the Kay procedure, Trialign (Mitralign, Boston, MA, USA) aiming to bicuspidise TV, MitraClip (Abbott Vascular, Abbott Park, Illinois, USA) mimicking Alfieri’s stitch, direct transcatheter annuloplasty with Cardioband (Valtech Cardio, Or Yehuda, Israel) and transcatheter Forma Repair (Edwards Lifesciences, Irvine, California, USA) providing a surface for leaflet coaptation. A multimodality imaging approach is fundamental for defining the pathophysiology of tricuspid regurgitation (TR), preprocedural planning and intraprocedural monitoring. Both 2-dimensional and 3-dimensional (3D) transthoracic echocardiography and transoesophageal echocardiography (TOE) are essential for grading and anatomical characterisation of TR, and evaluation of dimensions and function of right ventricle (RV) and estimation of pulmonary pressure. In particular, 3D echocardiography provides a better anatomical definition of TV apparatus and tricuspid annulus (TA) and additional information about the anatomical relationships of TV and surrounding structures. CT offers complementary information during the preprocedural planning especially for procedures targeting TA such as annular structure and dimensions, quality and amount of annular tissue and its relationship with the right coronary artery, and the sizing of the inferior vena cava. Moreover, appropriate patient selection is crucial. The best candidate seems to be a patient with functional TR due to predominant annular dilatation with modest apical tethering, at least partial preservation of leaflets coaptation, not severe pulmonary hypertension and not advanced RV dilation and dysfunction. An example of intraprocedural multimodality imaging approach with TOE, fluoroscopy, angiography and intracardiac echocardiography is also reported.

  • Echocardiography
  • Computed Tomography
  • Fluoroscopy
  • Catheter‐based coronary and valvular interventions
  • Valvular heart disease
  • Tricuspid Regurgitation

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  • Contributors FA, SS, EA: conception and design or analysis and interpretation of data; drafting of the manuscript.

    MT, CM, AL: analysis and interpretation of data and drafting of the manuscript.

    PD, FG, MES, OA, AC, FM: revising critically the manuscript for important intellectual content.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.