Computed tomography for transcatheter tricuspid valve development
Background Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to b...
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| Veröffentlicht in: | European radiology 2020-02, Vol.30 (2), p.682-690 |
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| creator | Chiaroni, Paul-Matthieu Ternacle, Julien Deux, Jean-François Boukantar, Madjid Mouillet, Gauthier Riant, Elisabeth Dubois-Randé, Jean-Luc Teiger, Emmanuel Lim, Pascal Gallet, Romain |
| description | Background
Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis.
Methods and results
A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR (
n
= 38), transcatheter aortic valve replacement (
n
= 89), or left atrial appendage closure (
n
= 68) were analyzed. Patients with TR (
n
= 68; 19 primary and 49 secondary) were compared with patients without (
n
= 127). Continuous variables with normal and non-normal distributions were compared using Student
t
test or Mann–Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08,
p
|
| doi_str_mv | 10.1007/s00330-019-06410-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04395027v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2280216184</sourcerecordid><originalsourceid>FETCH-LOGICAL-c409t-d121705c621776890e34b0cd77fa3761b63258a827db21cdff8ebede0cfc57a43</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EokvhD3BAkbjAIWXGduL4uFoBRVqpl_ZsOfakmyqJg52s1H9PQkqROHAa2fPNe2M_xt4jXCGA-pIAhIAcUOdQSoS8fMF2KAXPESr5ku1AiypXWssL9ialBwDQKNVrdiFQFqiV3LH9IfTjPJHPptCH-2jH02PWhJhN0Q7J2elEE62n1s1pbH12tt2ZMk9n6sLY0zC9Za8a2yV691Qv2d23r7eH6_x48_3HYX_MnQQ95R45KihcuRRVVhpIyBqcV6qxQpVYl4IXla248jVH55umopo8gWtcoawUl-zzpnuynRlj29v4aIJtzfX-aNY7kEIXwNUZF_bTxo4x_JwpTaZvk6OuswOFORnOK0TQCsWCfvwHfQhzHJaXrBRwLLFazflGuRhSitQ8b4Bg1jDMFoZZwjC_wzDlMvThSXque_LPI39-fwHEBqSlNdxT_Ov9H9lfmneTYQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2280216184</pqid></control><display><type>article</type><title>Computed tomography for transcatheter tricuspid valve development</title><source>SpringerLink Journals</source><creator>Chiaroni, Paul-Matthieu ; Ternacle, Julien ; Deux, Jean-François ; Boukantar, Madjid ; Mouillet, Gauthier ; Riant, Elisabeth ; Dubois-Randé, Jean-Luc ; Teiger, Emmanuel ; Lim, Pascal ; Gallet, Romain</creator><creatorcontrib>Chiaroni, Paul-Matthieu ; Ternacle, Julien ; Deux, Jean-François ; Boukantar, Madjid ; Mouillet, Gauthier ; Riant, Elisabeth ; Dubois-Randé, Jean-Luc ; Teiger, Emmanuel ; Lim, Pascal ; Gallet, Romain</creatorcontrib><description>Background
Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis.
Methods and results
A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR (
n
= 38), transcatheter aortic valve replacement (
n
= 89), or left atrial appendage closure (
n
= 68) were analyzed. Patients with TR (
n
= 68; 19 primary and 49 secondary) were compared with patients without (
n
= 127). Continuous variables with normal and non-normal distributions were compared using Student
t
test or Mann–Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08,
p
< 0.001), with a larger area (
p
< 0.0001), and septolateral (45.3 ± 8.0 mm,
p
< 0.0001) and anteroposterior (44.4 ± 7.4 mm,
p
< 0.0001) diameters than patients without. The distances from the TA to the coronary sinus, the right ventricular outflow tract, and the moderator band were respectively 11.4 ± 3.8 mm, 17.2 ± 3.4 mm, and 31.0 ± 6.7 mm, without differences between groups.
Conclusion
The transjugular access for TTVR is straighter and more reproducible than the transfemoral access. Prosthesis development may be challenged by the close position of the coronary sinus, the presence of a moderator band, and the large TA size of patients with severe TR.
Key Points
• The tricuspid annulus is larger in patients with severe tricuspid regurgitation, confirming existing data.
• The coronary sinus ostium is close to the tricuspid annulus, requiring a prosthesis with a short atrial length.
• The transjugular venous route may be the preferred access to the tricuspid annulus, straighter with less inter-individual variations than the transfemoral route.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-019-06410-6</identifier><identifier>PMID: 31451974</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Annuli ; Aortic valve ; Cardiac ; Catheters ; Computation ; Computed tomography ; Continuity (mathematics) ; Design optimization ; Diagnostic Radiology ; Electrocardiography ; Heart ; Imaging ; Internal Medicine ; Interventional Radiology ; Life Sciences ; Medicine ; Medicine & Public Health ; Neuroradiology ; Prostheses ; Radiology ; Regurgitation ; Route selection ; Tricuspid valve ; Ultrasound ; Ventricle</subject><ispartof>European radiology, 2020-02, Vol.30 (2), p.682-690</ispartof><rights>European Society of Radiology 2019</rights><rights>European Radiology is a copyright of Springer, (2019). All Rights Reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-d121705c621776890e34b0cd77fa3761b63258a827db21cdff8ebede0cfc57a43</citedby><cites>FETCH-LOGICAL-c409t-d121705c621776890e34b0cd77fa3761b63258a827db21cdff8ebede0cfc57a43</cites><orcidid>0000-0003-4595-509X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-019-06410-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-019-06410-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31451974$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.u-pec.fr/hal-04395027$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Chiaroni, Paul-Matthieu</creatorcontrib><creatorcontrib>Ternacle, Julien</creatorcontrib><creatorcontrib>Deux, Jean-François</creatorcontrib><creatorcontrib>Boukantar, Madjid</creatorcontrib><creatorcontrib>Mouillet, Gauthier</creatorcontrib><creatorcontrib>Riant, Elisabeth</creatorcontrib><creatorcontrib>Dubois-Randé, Jean-Luc</creatorcontrib><creatorcontrib>Teiger, Emmanuel</creatorcontrib><creatorcontrib>Lim, Pascal</creatorcontrib><creatorcontrib>Gallet, Romain</creatorcontrib><title>Computed tomography for transcatheter tricuspid valve development</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Background
Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis.
Methods and results
A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR (
n
= 38), transcatheter aortic valve replacement (
n
= 89), or left atrial appendage closure (
n
= 68) were analyzed. Patients with TR (
n
= 68; 19 primary and 49 secondary) were compared with patients without (
n
= 127). Continuous variables with normal and non-normal distributions were compared using Student
t
test or Mann–Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08,
p
< 0.001), with a larger area (
p
< 0.0001), and septolateral (45.3 ± 8.0 mm,
p
< 0.0001) and anteroposterior (44.4 ± 7.4 mm,
p
< 0.0001) diameters than patients without. The distances from the TA to the coronary sinus, the right ventricular outflow tract, and the moderator band were respectively 11.4 ± 3.8 mm, 17.2 ± 3.4 mm, and 31.0 ± 6.7 mm, without differences between groups.
Conclusion
The transjugular access for TTVR is straighter and more reproducible than the transfemoral access. Prosthesis development may be challenged by the close position of the coronary sinus, the presence of a moderator band, and the large TA size of patients with severe TR.
Key Points
• The tricuspid annulus is larger in patients with severe tricuspid regurgitation, confirming existing data.
• The coronary sinus ostium is close to the tricuspid annulus, requiring a prosthesis with a short atrial length.
• The transjugular venous route may be the preferred access to the tricuspid annulus, straighter with less inter-individual variations than the transfemoral route.</description><subject>Annuli</subject><subject>Aortic valve</subject><subject>Cardiac</subject><subject>Catheters</subject><subject>Computation</subject><subject>Computed tomography</subject><subject>Continuity (mathematics)</subject><subject>Design optimization</subject><subject>Diagnostic Radiology</subject><subject>Electrocardiography</subject><subject>Heart</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Life Sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroradiology</subject><subject>Prostheses</subject><subject>Radiology</subject><subject>Regurgitation</subject><subject>Route selection</subject><subject>Tricuspid valve</subject><subject>Ultrasound</subject><subject>Ventricle</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUFv1DAQhS0EokvhD3BAkbjAIWXGduL4uFoBRVqpl_ZsOfakmyqJg52s1H9PQkqROHAa2fPNe2M_xt4jXCGA-pIAhIAcUOdQSoS8fMF2KAXPESr5ku1AiypXWssL9ialBwDQKNVrdiFQFqiV3LH9IfTjPJHPptCH-2jH02PWhJhN0Q7J2elEE62n1s1pbH12tt2ZMk9n6sLY0zC9Za8a2yV691Qv2d23r7eH6_x48_3HYX_MnQQ95R45KihcuRRVVhpIyBqcV6qxQpVYl4IXla248jVH55umopo8gWtcoawUl-zzpnuynRlj29v4aIJtzfX-aNY7kEIXwNUZF_bTxo4x_JwpTaZvk6OuswOFORnOK0TQCsWCfvwHfQhzHJaXrBRwLLFazflGuRhSitQ8b4Bg1jDMFoZZwjC_wzDlMvThSXque_LPI39-fwHEBqSlNdxT_Ov9H9lfmneTYQ</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Chiaroni, Paul-Matthieu</creator><creator>Ternacle, Julien</creator><creator>Deux, Jean-François</creator><creator>Boukantar, Madjid</creator><creator>Mouillet, Gauthier</creator><creator>Riant, Elisabeth</creator><creator>Dubois-Randé, Jean-Luc</creator><creator>Teiger, Emmanuel</creator><creator>Lim, Pascal</creator><creator>Gallet, Romain</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0003-4595-509X</orcidid></search><sort><creationdate>20200201</creationdate><title>Computed tomography for transcatheter tricuspid valve development</title><author>Chiaroni, Paul-Matthieu ; Ternacle, Julien ; Deux, Jean-François ; Boukantar, Madjid ; Mouillet, Gauthier ; Riant, Elisabeth ; Dubois-Randé, Jean-Luc ; Teiger, Emmanuel ; Lim, Pascal ; Gallet, Romain</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-d121705c621776890e34b0cd77fa3761b63258a827db21cdff8ebede0cfc57a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Annuli</topic><topic>Aortic valve</topic><topic>Cardiac</topic><topic>Catheters</topic><topic>Computation</topic><topic>Computed tomography</topic><topic>Continuity (mathematics)</topic><topic>Design optimization</topic><topic>Diagnostic Radiology</topic><topic>Electrocardiography</topic><topic>Heart</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Life Sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroradiology</topic><topic>Prostheses</topic><topic>Radiology</topic><topic>Regurgitation</topic><topic>Route selection</topic><topic>Tricuspid valve</topic><topic>Ultrasound</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chiaroni, Paul-Matthieu</creatorcontrib><creatorcontrib>Ternacle, Julien</creatorcontrib><creatorcontrib>Deux, Jean-François</creatorcontrib><creatorcontrib>Boukantar, Madjid</creatorcontrib><creatorcontrib>Mouillet, Gauthier</creatorcontrib><creatorcontrib>Riant, Elisabeth</creatorcontrib><creatorcontrib>Dubois-Randé, Jean-Luc</creatorcontrib><creatorcontrib>Teiger, Emmanuel</creatorcontrib><creatorcontrib>Lim, Pascal</creatorcontrib><creatorcontrib>Gallet, Romain</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central 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Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chiaroni, Paul-Matthieu</au><au>Ternacle, Julien</au><au>Deux, Jean-François</au><au>Boukantar, Madjid</au><au>Mouillet, Gauthier</au><au>Riant, Elisabeth</au><au>Dubois-Randé, Jean-Luc</au><au>Teiger, Emmanuel</au><au>Lim, Pascal</au><au>Gallet, Romain</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Computed tomography for transcatheter tricuspid valve development</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>30</volume><issue>2</issue><spage>682</spage><epage>690</epage><pages>682-690</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Background
Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis.
Methods and results
A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR (
n
= 38), transcatheter aortic valve replacement (
n
= 89), or left atrial appendage closure (
n
= 68) were analyzed. Patients with TR (
n
= 68; 19 primary and 49 secondary) were compared with patients without (
n
= 127). Continuous variables with normal and non-normal distributions were compared using Student
t
test or Mann–Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08,
p
< 0.001), with a larger area (
p
< 0.0001), and septolateral (45.3 ± 8.0 mm,
p
< 0.0001) and anteroposterior (44.4 ± 7.4 mm,
p
< 0.0001) diameters than patients without. The distances from the TA to the coronary sinus, the right ventricular outflow tract, and the moderator band were respectively 11.4 ± 3.8 mm, 17.2 ± 3.4 mm, and 31.0 ± 6.7 mm, without differences between groups.
Conclusion
The transjugular access for TTVR is straighter and more reproducible than the transfemoral access. Prosthesis development may be challenged by the close position of the coronary sinus, the presence of a moderator band, and the large TA size of patients with severe TR.
Key Points
• The tricuspid annulus is larger in patients with severe tricuspid regurgitation, confirming existing data.
• The coronary sinus ostium is close to the tricuspid annulus, requiring a prosthesis with a short atrial length.
• The transjugular venous route may be the preferred access to the tricuspid annulus, straighter with less inter-individual variations than the transfemoral route.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31451974</pmid><doi>10.1007/s00330-019-06410-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4595-509X</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | European radiology, 2020-02, Vol.30 (2), p.682-690 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_04395027v1 |
| source | SpringerLink Journals |
| subjects | Annuli Aortic valve Cardiac Catheters Computation Computed tomography Continuity (mathematics) Design optimization Diagnostic Radiology Electrocardiography Heart Imaging Internal Medicine Interventional Radiology Life Sciences Medicine Medicine & Public Health Neuroradiology Prostheses Radiology Regurgitation Route selection Tricuspid valve Ultrasound Ventricle |
| title | Computed tomography for transcatheter tricuspid valve development |
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