Tricuspid TEER — Advanced Procedural Strategies-Dr. Miyasaka Imaging slides

Dr. Miyasaka Imaging slides

Pdf Summary

This presentation by Dr. Rhonda Miyasaka focuses on the use of transesophageal echocardiography (TEE), particularly 3D multiplanar reconstruction (MPR), for planning and guiding transcatheter tricuspid valve edge-to-edge repair (T-TEER). Key points include:

1. <strong>Key TEE Views for T-TEER:</strong> Essential views include long axis (septal-lateral), commissural (anterior-posterior), and gastric short axis, used to assess tricuspid valve (TV) morphology, leaflets, commissures, coaptation gaps, and device leads. Switching between multiple windows can be time-consuming and error-prone.

2. <strong>3D MPR Advantages:</strong> 3D MPR simultaneously displays multiple imaging planes, offering four views at once, bridging preprocedural imaging and intraprocedural guidance. This helps precisely evaluate leaflet length, coaptation gaps, subvalvular apparatus, and lead position, important for grasping and device placement.

3. <strong>Image Optimization:</strong> High-quality 2D imaging is critical since 3D imaging depends on it. Optimization tips include proper probe positioning, managing shadowing artifacts (sometimes clarified by fluoroscopy), and positioning patients with a pressure bag under the right shoulder.

4. <strong>Evaluating Challenges:</strong> 3D MPR facilitates detection of gaps and lead interactions that are difficult to appreciate on 2D imaging, enhancing planning and reducing procedural risks.

5. <strong>Intraprocedural Guidance:</strong> The presentation describes using MPR to guide leaflet grasping, clip positioning, and assessment of final valve repair results in real time.

6. <strong>Summary and Tips:</strong> 3D MPR acts as a universal language across imaging platforms (esophageal, gastric, intracardiac echocardiography). The consistent formula includes grasping view, short axis, commissural, and enface views. Key to success is optimizing 2D image quality, using MPR to anticipate challenges, and continuous real-time monitoring of device position.

Overall, Dr. Miyasaka emphasizes that mastering TEE and 3D MPR optimizes procedural outcomes in T-TEER by enhancing visualization, reducing errors, and improving intraprocedural decision-making.

Keywords

Transesophageal echocardiography

TEE

3D multiplanar reconstruction

3D MPR

Transcatheter tricuspid valve edge-to-edge repair

T-TEER

tricuspid

Tricuspid valve imaging

Leaflet grasping

Intraprocedural guidance

Image optimization