Computed tomography for planning transcatheter tricuspid valve therapy.
OBJECTIVE
Percutaneous transcatheter tricuspid valve therapy is an evolving treatment option for patients with significant tricuspid regurgitation (TR) deemed too fragile for open heart surgery. The present study proposes comprehensive anatomical evaluation of the tricuspid valve, right ventricle (RV), and vena cavae and its spatial relationships with the right coronary artery (RCA) using computed tomography (CT) and investigates the implications for suitability for current technologies.


RESULTS
A total of 250 patients (mean age 80 ± 7.2 years, 52.4% men) undergoing CT were divided according to the presence of moderate or severe TR (≥3+, n = 40) and less than moderate TR (<3+, n = 210). Tricuspid valve annulus, RV, and vena cavae dimensions and the course of the RCA relative to the tricuspid annulus were evaluated. Patients with TR ≥ 3+ showed significantly larger dimensions of the tricuspid annulus, RV and vena cavae. In 64.8% of patients, the RCA coursed along the tricuspid valve annulus. Patients with TR <3+ showed more frequently a course of the RCA superior to the tricuspid annulus at the levels of the anterior and the posterior tricuspid leaflet compared with their counterparts (12.4% vs. 0%, P = 0.019). A less favourable course of the RCA (≤2.0 mm distance to the annulus) for current annuloplasty techniques was observed at the level of the anterior tricuspid and posterior leaflets in respective 12.5 and 27.5% of patients with TR ≥3+.


CONCLUSIONS
The present study proposes a first systematic approach based on CT to define the patient suitability for current transcatheter tricuspid valve devices.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Philippe J
PJ
van Rosendael
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.|Department of Cardiology, AHEPA University Hospital, St. Kiriakidis 1, P.O. 54636. Thessaloniki, Greece.
Vasileios
V
Kamperidis
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.|Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd. 119074, Singapore.
William K F
WK
Kong
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Alexander R
AR
van Rosendael
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Frank
F
van der Kley
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Nina
N
Ajmone Marsan
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Victoria
V
Delgado
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Jeroen J
JJ
Bax
D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods; D003331:Coronary Vessels / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D010347:Patient Care Planning; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014682:Vena Cava, Inferior / Q000033:anatomy & histology / Q000000981:diagnostic imaging
Computed tomography; Transcatheter ; Tricuspid valve 