Tricuspid TEER — Advanced Procedural Strategies-Dr. Singh 3D ICE Imaging slides

Dr. Singh 3D ICE Imaging slides

Pdf Summary

This presentation by Dr. Gagan D. Singh focuses on the use of 3D Intracardiac Echocardiography (3D ICE) for procedural guidance during Transcatheter Tricuspid Valve Edge-to-Edge Repair (T-TEER). Traditional imaging during T-TEER typically relies on transesophageal echocardiography (TEE) via midesophageal (ME) and transgastric (TG) windows for steps such as trajectory alignment, right ventricular (RV) advance, grasping, leaflet insertion assessment, and clip deployment. However, challenges arise when ME or TG views are suboptimal, leading to difficulties in accurately grasping and assessing leaflet insertion.<br /><br />3D ICE serves both an adjunctive and routine role. As adjunctive imaging, 3D ICE complements TEE when ME/TG windows do not provide adequate visualization, especially during grasping and leaflet insertion assessment. In some centers, 3D ICE is increasingly used routinely to guide nearly all major steps of T-TEER implantation. The workflow integrates ME and TG imaging for initial steps, then incorporates 3D ICE for critical grasping and leaflet evaluation, followed by final deployment under TEE.<br /><br />A clinical case highlighted demonstrates repeated failed grasp attempts using conventional TEE, resolved by switching to 3D ICE, which allowed improved visualization of clip arms and leaflets through carefully adjusted imaging angles and elevation tilts. This technique, termed "3D Navigation," optimizes the 3D ICE imaging plane to best visualize anatomy and device structures in real time.<br /><br />The presentation underscores that while 3D ICE is not mandatory for every T-TEER procedure, it is becoming standard in cases with limited conventional imaging windows. It requires a well-coordinated team approach and experience using simulators and optimal cases to become proficient. Overall, 3D ICE expands imaging options, improving procedural success in challenging tricuspid valve repairs.

Keywords

3D Intracardiac Echocardiography

3D ICE

Transcatheter Tricuspid Valve Edge-to-Edge Repair

T-TEER

tricuspid

Transesophageal Echocardiography

TEE

Midesophageal Window

Transgastric Window

Leaflet Insertion Assessment

3D Navigation