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Eur Heart J Case Rep
Eur Heart J Case Rep
ehjcr
European Heart Journal. Case Reports
2514-2119
Oxford University Press UK

10.1093/ehjcr/ytae489
ytae489
Cardiovascular Flashlight
AcademicSubjects/MED00200
Eurheartj/31
Eurheartj/35
Eurheartj/39
Eurheartj/41
Eurheartj/48
Eurheartj/55
Four-dimensional intracardiac echocardiography for guidance of tricuspid transcatheter edge-to-edge repair: a case report
van den Dorpel Mark M P Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, office Nt-645, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Ben Ren Claire Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, office Nt-645, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

https://orcid.org/0000-0002-2732-1205
Van Mieghem Nicolas M Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, office Nt-645, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Gue Ying Xuan Handling Editor
Dikou Marie-Luise Editor
Biasco Luigi Editor
Corresponding author. Tel: +31 10 7035260, Fax: +31 10 7035254, Email: n.vanmieghem@erasmusmc.nl
Conflict of interest: N.M.V.M. has received the following contributions: grants or contracts from Abbott, Boston Scientific, Biotronic, Edwards Lifesciences, Medtronic, Pulsecath BV, Abiomed, and Daiichi Sankyo; consulting fees from JenaValve, Daiichi Sankyo, Abbott, Boston Scientific, and Medtronic; payment or honoraria for lectures, presentations, speakers, manuscripts, and educational events from Abiomed, Amgen, and JenaValve. M.M.P.v.d.D. and C.B.R. have nothing to declare.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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Transoesophageal echocardiography (TEE) is considered the standard imaging guidance tool for tricuspid transcatheter edge-to-edge repair (TEER). Common limitations of TEE imaging of the tricuspid valve (TV) include lower far-field spatial resolution and acoustic shadows stemming from calcific structures and metal containing intracardiac devices. The tricuspid leaflets may be particularly challenging to visualize during tricuspid TEER procedures. Intracardiac echocardiography (ICE) may overcome these intrinsic limitations.

A novel ICE catheter (ACUSON AcuNav Volume 4D ICE Catheter, Siemens, Erlangen, Germany) allows real-time 4D acquisition of high-quality 2D and 3D images, as well as simultaneous multi-planar reconstructions of the 3D data, like conventional 3D TEE.

We compared 4D ICE and TEE imaging during a tricuspid TEER procedure (Figure 1; Supplementary material online, Video S1). All key TEE imaging views for tricuspid TEER in terms of device orientation, leaflet capturing, and tricuspid regurgitation assessment could be obtained with 4D ICE (Panels A–E). Particularly, 4D ICE could generate the imaging view where the TEER device perpendicularity (to the leaflet coaptation line) can be assessed, like the TEE transgastric TV en-face view (Panel B).

In our case, 4D ICE image quality was at best equivalent to that of TEE. Thus, we currently consider 4D ICE as complementary to TEE. It may be considered as an alternative to TEE in cases in which TEE is not feasible or fails to accurately visualize the TV.

Key imaging views for tricuspid transcatheter edge-to-edge repair were obtained by transoesophageal echocardiography and intracardiac echocardiography. 4D ICE, 4-dimensional intracardiac echocardiography; TEE, transoesophageal echocardiography; TR, tricuspid regurgitation.

Supplementary Material

ytae489_Supplementary_Data

Supplementary material

Supplementary material is available at European Heart Journal – Case Reports online.

Consent: The authors confirm that written consent for submission and publication of this case report including images and associate text has been obtained from the patient in line with the Committee on Publication Ethics (COPE) guidance.

Funding: None declared.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.
