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Review
. 2022 Aug 10;6(4):100071.
doi: 10.1016/j.shj.2022.100071. eCollection 2022 Aug.

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

Scott M Chadderdon  1 , Mackram F Eleid  2 , Jeremy J Thaden  2 , Raj Makkar  3 , Mamoo Nakamura  3 , Vasilis Babaliaros  4 , Adam Greenbaum  4 , Patrick Gleason  4 , Susheel Kodali  5 , Rebecca T Hahn  5 , Konstantinos P Koulogiannis  6 , Leo Marcoff  6 , Paul Grayburn  7 , Robert L Smith  7 , Howard K Song  1 , D Scott Lim  8 , William A Gray  9 , Katie Hawthorne  9 , Florian Deuschl  10 , Akhil Narang  11 , Charles Davidson  11 , Firas E Zahr  1
Affiliations
Review

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

Scott M Chadderdon et al. Struct Heart. .

Abstract

Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages. The aim of this article was to describe the in vitro wet lab-based imaging work done to facilitate the best approach to 3D MPR ICE imaging and the procedural experience gained with 3D MPR ICE in tricuspid TEER procedures with the PASCAL device.

Keywords: Intracardiac echocardiography; Transcatheter tricuspid edge-to-edge repair; Tricuspid regurgitation.

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Conflict of interest statement

Scott M. Chadderdon received grant support from Medtronic Inc and GE Healthcare Imaging and is an imaging education consultant for Edwards Lifesciences and Medtronic Inc. Firas E. Zahr received grant support from Siemens Healthineers Inc and is an education consultant for Medtronic Inc. Howard K. Song is an education consultant for Medtronic Inc. Raj Makkar received grant support from Edwards Lifesciences and St. Jude Medical and personal fees from Abbott Vascular, Cordis, Medtronic Inc. Patrick Gleason received research grants from Edwards Lifesciences, Medtronic Inc, and Abbott. Susheel Kodali is a consultant for Admedus, Meril Lifesciences, JenaValve, Abbott Vascular. Equit in Dura Biotech, MicroInterventional Devices, Thubrikar Aortic Valve Inc, and Supira, Admedus. Rebecca T. Hahn received speaker fees from Abbott Structural, Baylis Medical, and Edwards Lifesciences; has institutional educational and consulting contracts for which she receives no direct compensation with Abbott Structural, Boston Scientific, Edwards Lifesciences, and Medtronic; has equity with Navigate; and is the chief scientific officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Paul Grayburn received research grants from Abbott Vascular, Edwards Lifesciences, Medtronic, W.L. Gore, Cardiovalve, and Neochord; serves on advisory boards of and received honoraria from Abbott Vascular, Edwards Lifesciences, Medtronic, W.L. Gore, and 4C Medical. Robert L. Smith received institutional grant support from Edwards Lifesciences, Abbott, and Cryolife; serves on the advisory board for Edwards Lifesciences; and is a speaker for Abbott and Cryolife. D. Scott Lim received grant support (institutional) from Abbott, Boston Scientific, Edwards, Medtronic; and consulting (personal) from Keystone, Valgen, Venus, Gore. William A. Gray received consultant fees from Edwards Lifesciences. Florian Deuschl is a full-time employee of Edwards Lifesciences. Charles Davidson received research grant support and consultant for Edwards Lifesciences. The other authors had no conflicts to declare.

Figures

Figure 1
Figure 1
Animal cadaver beating heart model with PASCAL repair system, Oscor steerable sheath, Siemens ACUSON AcuNav Volume intracardiac echocardiography (ICE) catheter in long axis view (a) and en-face view (b). Abbreviations: IVC, Inferior vena cava; TEE, transesophageal echocardiography.
Figure 2
Figure 2
Still frame 2D ICE image of inflow/outflow view of tricuspid valve with anterior and posterior leaflets (a). Still frame 3D ICE imaging planes with posterior (P) and anterior (A) leaflets in the inflow/outflow view with the red plane aligned parallel to the septal leaflet. The green plane, orthogonal view, has been unlocked and counter clockwise rotated to align for a septal (S) and anterior/lateral (L) leaflet grasping view. The blue plane represents the multiplanar reconstruction rendered 3D short axis view of leaflet tips with the corresponding 3D volume (b). Abbreviations: 2D, two-dimensional; 3D, three-dimensional; ICE, intracardiac echocardiography; MPR, multiplanar reconstruction.
Figure 3
Figure 3
Siemens AcuNav intracardiac echocardiography (ICE) catheter superior in mock right atrium for imaging alignment of PASCAL implant in the anterior-septal position (a) and withdrawn inferiorly for imaging alignment of PASCAL implant in the posterior-septal position (b). Abbreviation: TEE, transesophageal echocardiography.
Figure 4
Figure 4
Flowchart of two-dimensional (2D) and three-dimensional (3D) intracardiac echocardiography (ICE) experience in CLASP II TR Early Feasibility Study (EFS). Abbreviations: AP, anterior-posterior; AS, anterior-septal; PS, posterior-septal; TEE, transesophageal echocardiography; TR, tricuspid regurgitation.
Figure 5
Figure 5
Strengths and limitations of two-dimensional (2D) and three-dimensional (3D) intracardiac echocardiography (ICE). Abbreviations: FPS, frames per second; MPR, multiplanar reconstruction; TEE, transesophageal echocardiography; VPS, volume per second.
See this image and copyright information in PMC

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