Percutaneous Treatment of Tricuspid Regurgitation

Abstract

Tricuspid valve regurgitation is one of the most common valvular disorders and moderate to severe tricuspid regurgitation is consistently associated to an increased morbidity and mortality. From an etiopathological perspective, tricuspid regurgitation can be classified in primary, due to the organic disease of any of the valve components, or secondary, as a result of tricuspid valve annulus dilatation, adverse right ventricular remodeling and tricuspid valve leaflet tethering. Despite its poor prognosis, most patients with tricuspid insufficiency are managed conservatively and only those with concomitant left heart valvular disease do finally go surgery in the real-world setting. In fact, outcomes of conventional surgery in patients with isolated tricuspid regurgitation are poor and this approach has not proven yet any survival benefit over stand-alone medical therapy. Given this unmet need, new transcatheter techniques have been developed in the last years, including leaflet plication, percutaneous annuloplasty and valve implantation in either the tricuspid position (orthotopic implantation) or in a different position such as the vena cava (heterotopic implantation). These techniques, with promising outcomes, are seen as an interesting alternative to open-heart surgery given the much lower periprocedural risk.

Exploratory use of intraprocedural transesophageal echocardiography to guide implantation of the leadless pacemaker

“…This important landmark on the RV side of the IVS could serve as an important landmark for localization of the septum. 14 We used this septal papillary muscle as the reference point but did not aim to implant the LP onto the papillary muscle because it might reduce stability and negatively influence the LP pacing parameters. Numerically, the LP was found to be closer to the PV (4.2 cm) than the TV (4.9 cm), which is in keeping with suggested nonapical implantation.…”