Role of Echocardiography in TV-Clipping

Symptomatic, severe tricuspid regurgitation (TR) and right ventricular (RV) dysfunction are closely related, and lead to right-sided heart failure (HF) with repeat hospitalizations and a poor prognosis especially in cases with prohibitive surgical risk.If operable, tricuspid valve (TV) repair or replacement is guideline-recommended surgical techniques. But many for patients at the time of diagnosis operation seems too risky, taking an operative mortality of 10- 30 % into consideration. Therefore, alternative techniques to surgery are highly demanded. In recent years, novel transcatheter treatment options were developed for treating TR, particularly in patients who were initially managed medically. Patients with severe TR and prior open-heart surgery are often deemed at high or prohibitive operative risk for reoperation, and are thus better candidates for less invasive transcatheter techniques. Patients with functional TR and progressive RV dysfunction with right heart failure, despite optimal medical therapy, may also benefit from a transcatheter-based intervention if an isolated TV repair is not indicated. Transcatheter edge-to-edge repair method, which was originally developed for the treatment of severe mitral regurgitation (MR), has been successfully applied for the treatment of severe TR. Some case reports as well as case series demonstrated technical feasibility, procedural safety, and a promising early clinical benefit. TV-Clipping needs to be performed under direct imaging guidance, usually using echocardiography and fluoroscopy. Accurate knowledge of the anatomic and functional imaging of the TV apparatus is crucial for a successful procedure.This presentation aims to provide a practical guide for echocardiographic monitoring during percutaneous TV –Clipping by reporting our initial experience with 3 cases using 2D and 3D echocardiographic guidance.