State-of-the-art intra-procedural imaging for the mitral and tricuspid PASCAL Repair System

Hahn, Rebecca T.; Kodali, Susheel

doi:10.1093/ehjci/jeab040

Cited by 20 publications

(16 citation statements)

References 35 publications

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“… 12 Advanced transesophageal echocardiography (TEE) with 2D and 3D multiplanar reconstruction (MPR) is a key component for transcatheter tricuspid procedures and may be most critical in TEER, as appropriate device alignment and leaflet capture are essential. 13 There are many factors in procedural imaging that may impact appropriate TEE visibility of leaflets when performing a tricuspid TEER procedure. These include shadowing from left-sided surgical aortic and mitral prostheses, tricuspid annular bands/rings, atrial septal hypertrophy, as well as anatomic thoracic features such as a horizontal heart axis, hiatal hernias, or additional thoracic/esophageal pathology.…”

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confidence: 99%

Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair

et al. 2022

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Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair

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“…Numerous research has looked into the impact of utilizing various VC width and EROA cutoffs in this setting. They consistently demonstrated a poorer prognosis for patients with either massive or torrential TR 15–18 …”

Section: Discussionmentioning

confidence: 98%

“…They consistently demonstrated a poorer prognosis for patients with either massive or torrential TR. [15][16][17][18] Over the past 20-25 years, cardiovascular magnetic resonance (CMR) has established itself as the gold standard for assessing left and right ventricular mass, volume, and function. Additionally, it has developed into a trustworthy and precise tool for calculating the volumetric quantification of the heart valves utilizing a number of methods that are independent of jet morphology.…”

Section: Discussionmentioning

confidence: 99%

“…Assessing valvular regurgitation with color Doppler involves measuring proximal isovelocity surface area (PISA) convergence method, vena contracta (VC), and TR the jet area. These well‐known and commonly used criteria do, however, have a number of drawbacks that should be taken into account 14–19 . For quantitative valve assessment, cardiac magnetic resonance imaging (CMR) frequently serves as gold standard 19–22 .…”

Section: Introductionmentioning

confidence: 99%

“…These well-known and commonly used criteria do, however, have a number of drawbacks that should be taken into account. [14][15][16][17][18][19] For quantitative valve assessment, cardiac magnetic resonance imaging (CMR) frequently serves as gold standard. [19][20][21][22] The ferromagnetic effects of metallic implants, claustrophobia, respiratory artifacts, arhythmia artifacts, claustrophobia, lack of technology in all centers, and a shortage of imaging professionals to interpret images are some of the drawbacks of CMR.…”

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The right ventricle systolic force ratio could predict the severity of the tricuspid regurgitation‐RIVIERA ratio

Acar

İzcı

Dönmez

et al. 2023

J of Clinical Ultrasound

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Purpose For assessing the severity of tricuspid regurgitation (TR), there is no gold standard. We developed a parameter, the right ventricular systolic force ratio—RIVIERA, using the continious wave Doppler analysis of TR and pulsed‐wave analysis of the right ventricle outflow tract. We hypothesized that the RIVIERA would facilitate the ability to identify severe TR in clinical settings. Materials and Methods We obtained data from routine transthoracic echocardiograms. All records reporting no or mild TR (n = 732), moderate TR (n = 584), and severe TR (n = 519) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, the RIVIERA, and right‐sided chamber volumes. Results Significant linear trends were demonstrated for right atrial volume index, end‐diastolic volume index, RVOT velocity time integral, TR jet area, TR‐Vmax, TR‐VTI, TR acceleration, VC width, EROA with increasing TR severity. Independent predictors of severe RT included RIVIERA <4.8, VC width ≥0.7 cm, TR jet area > 10 cm2, and EROA ≥0.4 cm2. Conclusion The RIVIERA is a feasible, effective, and independent predictor of severe TR that enhances established techniques for estimating TR severity. For clinical decision‐making and management, accurate measurement and classification of TR severity are essential. Therefore, it should be thought about include the RIVIERA in the integrative method to assessing TR severity.

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The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area

Paukovitsch,

Felbel,

Tadic

et al. 2024

Clin Res Cardiol

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Background Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for functional mitral regurgitation (FMR) associated with a risk of creating iatrogenic stenosis. Objectives To investigate the impact of the P10 and its larger spacer compared to the narrower Ace and its smaller spacer on reduction of mitral valve orifice area (MVOA) during M-TEER. Methods Consecutive patients undergoing M-TEER for treatment of severe FMR were screened retrospectively. Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA ≥ 3.5cm2 were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold. Results Seventy-two patients (81.0 years, IQR {74.3–85.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity (p = 0.66), MR reduction (p = 0.73), and body surface area (p = 0.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm2, p = 0.18), however, residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm2, p = 0.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (− 45.9 ± 7.6 vs. − 56.3 ± 7.0%, p < 0.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar. Conclusion In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis. Graphical Abstract Seventy-two patients treated for functional mitral regurgitation (FMR) with the narrower PASCAL Ace featuring a smaller spacer (n = 40) or the broader P10 with a larger spacer (n = 32) were included in this study. Using 3D TEE and multiplanar reconstruction for direct planimetry, mitral valve orifice areas (MVOA) were measured before and after device implantation. Only patients with central device positioning were included. The dimensions of the PASCAL device platform are shown as well. Note the larger space and broader design of the P10 compared to the PASCAL Ace. The difference in MVOA reduction amounted to 10%, which translates into roughly 0.5 cm2 based on an average MV found in this study.

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State-of-the-art intra-procedural imaging for the mitral and tricuspid PASCAL Repair System

Cited by 20 publications

References 35 publications

Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair

Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair

The right ventricle systolic force ratio could predict the severity of the tricuspid regurgitation‐RIVIERA ratio

The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area

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