Tricuspid TEER With 4D ICE Guidance

Images/courtesy Erasmus MC, The Netherlands

Imaging Corner

Tricuspid TEER With 4D ICE Guidance

Images/courtesy Erasmus MC, The Netherlands

October 2023

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Transesophageal echocardiography (TEE) is considered the gold standard for image guidance during tricuspid valve repair. However, the ability to position the TEE ultrasound probe is limited by the esophageal path, the distance to the tricuspid valve, and challenging transgastric en-face views. Four-dimensional intracardiac echocardiography (4D ICE) overcomes TEE’s limitations and provides unobstructed adjacent views of the tricuspid valve and leaflet anatomy. In this case, a patient with severe tricuspid regurgitation (Figure 1) presented for tricuspid transcatheter edge-to-edge repair (TEER). The use of TEE with an ICE catheter (the ACUSON AcuNav Volume ICE catheter, Siemens Healthineers) provided detailed views of tricuspid leaflet anatomy (Figure 2), enabling accurate deployment of a leaflet approximation device. Following TEER, tricuspid regurgitation was significantly reduced (Figure 3) and the patient reported symptomatic improvement.