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CT for Planning Transcatheter Tricuspid Valve Therapy
Study Questions:
Can cardiac computed tomography (CT) reliably evaluate right-sided cardiac anatomy? And is there a difference in right-sided structures as imaged by CT between patients with versus without significant tricuspid regurgitation (TR)?
Methods:
This study examined 250 patients undergoing CT for possible transcatheter aortic valve replacement, after excluding 24 patients with inadequate CT image quality of right-sided structures. The anatomic relationship of right-sided structures on CT was compared between patients with ≥ moderate versus < moderate TR. Patients with primary TR were not included in this study.
Results:
Among the 250 patients (91%) with adequate visualization of right-sided structures, individuals with ≥ moderate (vs. less) TR had differences in the relationship between the right coronary artery and the tricuspid valve annulus, a larger annulus size, and a larger inferior vena cava size (p < 0.05 for each). There were no differences between groups in the distance from the right coronary artery and the tricuspid valve annulus or posterior leaflet.
Conclusions:
CT can adequately visualize right-sided structures in a large majority of patients considered for transcatheter aortic valve replacement, and observes anatomic differences in right-sided structures between patients with versus without at least moderate TR.
Perspective:
There are a range of strategies under investigation for percutaneous treatment of TR. These options will likely require imaging to determine the spatial relationships between related structures, including the annulus, right coronary artery, right ventricle, right atrium, and vena cava. This study finds that CT can visualize these structures in a large majority of patients. As would be expected, these data observe differences in right-sided anatomy between patients with at least moderate (vs. less) TR. We do not have a gold reference for comparison to determine the accuracy of these measurements, but this study suggests that CT measurements are feasible, and provides examples of potential standardized measurements that could be considered for transcatheter procedures of the tricuspid valve.
Keywords: Cardiac Surgical Procedures, Diagnostic Imaging, Heart Valve Diseases, Tomography, Tomography, X-Ray Computed, Transcatheter Aortic Valve Replacement, Tricuspid Valve Insufficiency, Vena Cava, Inferior
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