Transcatheter Tricuspid Valve Therapy: From Anatomy to Intervention

Nowadays, severe symptomatic tricuspid regurgitation (TR) affects millions of persons worldwide. However, the benefit of surgical correction of isolated secondary TR remains controversial because of the increased risk of periprocedural mortality and morbidity. In recent years, novel transcatheter tricuspid valve interventions (TTVI) were developed to treat TR, so that TTVI is currently considered in symptomatic, inoperable, anatomically eligible patients. TTVI can be divided into these five domains: edge-to-edge leaflet repair, tricuspid annuloplasty, caval implants, spacer, and total valve replacement. Each transcatheter intervention needs specific imaging protocols for assessing the anatomical feasibility and consequentially predicting the procedural success. This review summarizes the available multimodality imaging tools for screening patients with TR, and identifies anatomical characteristics to choose the best option for the patient.

A Practical Approach to Combined Transcatheter Mitral and Tricuspid Valve Intervention

Concomitant tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR). While current guidelines recommend repair of both valves at the time of surgery when feasible, high risk patients are often undertreated, leading to significant morbidity and mortality. With advances in transcatheter edge-to-edge repair (TEER) devices and technique, combined TEER for treating significant MR and TR has emerged as a new tool for heart failure management. Recent evidence has shed light on which patients with severe TR should be targeted for transcatheter intervention either in isolation or in combination with a MV TEER procedure and allows for expanded treatment options in patients who otherwise would be limited to medical management. Technological advancements remain ahead of robust clinical data, and thus randomized clinical studies in patients with severe MR and TR will be instrumental in determining the best approach in treating these patients with transcatheter therapies.

Post Infarction Ventricular Septal Rupture: Transcatheter intervention or Surgical repair?

ABSTRACT Post infarction ventricular septal rupture (PIVSR) is an infrequent but potentially fatal complication of acute myocardial infarction. • The 30-day mortality rate with the transcatheter approach when performed in the acute phase (less than two weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within three weeks). • There is no correlation between defect size and mortality. • NYHA class IV and time to VSD closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.

Hybrid Surgical Repair for Recurrent Coarctation of the Transvers Arch: Case Report

The incidence of postoperative recurrent coarctation of the aorta ranges from 5% to 50%, and largely depends on the age at initial repair. Due to the increased fibrosity and rigidity of the aorta in older age, stent placement is preferred instead of balloon angioplasty, resulting in an almost complete relief of the gradient in >95% of the patients. In patients with transverse arch hypoplasia, transcatheter intervention with further surgical intervention may be needed, and the use of stenting was shown to be effective in the treatment of patients with hypoplastic isthmus, arch or tubular coarctation. In this case of a late re-coarctation, we preferred to apply a hybrid technique for treatment. The first step of the treatment was debranching of the brachiocephalic and left common carotid arteries with upper mini median sternotomy. On the following day, the patient underwent a successful stent placement to the transvers arch.

Transcatheter Treatment of Complex Pulmonic and Aortic Valvular Disease Following Failed Ross Procedure

A 63 year old male with congenital bicuspid aortic valve status post Ross procedure complicated by multiple sternotomies to treat a failed pulmonic homograft and pseudoaneurysm repair of both ventricular outflow tracts, bioprosthetic aortic valve replacement with subsequent endocarditis who presented with recurrent pulmonic/aortic vavlulopathy successfully treated with transcatheter intervention.

Transcatheter Closure of Atrial Septal Defect and Balloon Pulmonary Valvuloplasty with Inoue Balloon in Adult Patients.

Secundum type atrial septal defect combined with pulmonic stenosis is a relatively uncommon condition in adult patients. When occurred separately they can be treated with transcatheter intervention. When they occur together ideal treatment option is not clear. We report a case of combined percutaneous pulmonary valvuloplasty done with the Inoue balloon and transcatheter atrial septal defect closure in an adult patient.