Author + information
- Brian O’Neill, MD∗,
- Dee Dee Wang, MD†∗ (, )
- Milan Pantelic, MD‡,
- Thomas Song, MD‡,
- Mayra Guerrero, MD†,
- Adam Greenbaum, MD† and
- William W. O’Neill, MD†
- ∗Temple Heart and Vascular Institute, Temple University, Philadelphia, Pennsylvania
- †Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan
- ‡Department of Radiology, Henry Ford Health System, Detroit, Michigan
- ↵∗Address for correspondence:
Dr. Dee Dee Wang, Advanced Structural Heart Imaging, Division of Cardiology, 2799 West Grand Boulevard, K-14, Detroit, Michigan, 48202.
- 3D print
- caval tricuspid valve
- computed tomography (CT)
- peri-procedural planning
- transcatheter valve replacement
- tricuspid regurgitation
This iPIX illustrates 3-dimensional (3D) printing guided periprocedural, multimodality pictorial planning performed for a successful transcatheter caval valve implantation (CAVI). A 57-year-old patient with severe mitral valve regurgitation status post–mitral ring placement in 2001 (28-mm Cosgrove, Edwards Lifesciences Corp., Irvine, California) and Hodgkin’s lymphoma treated with mantle radiation therapy had done well for several years before the development of abdominal distention and lower extremity edema. She had recurrent hospitalizations for abdominal ascites requiring large-volume paracentesis. Two-dimensional echocardiography showed a structurally normal tricuspid valve with severe tricuspid regurgitation and mildly reduced right ventricular systolic function. The patient was evaluated for isolated tricuspid valve surgery and heart transplantation, which were ultimately deemed a prohibitive surgical risk given the history of chest radiation, and she was referred for CAVI.
Pre-CAVI imaging is performed with contrast-enhanced, retrospectively electrocardiogram-gated computed tomography angiography acquisition, extending from the lower chest through the abdomen for dynamic evaluation of the extent of tricuspid regurgitation into the inferior vena cava (IVC). CAVI sizing is performed in the right atrium (RA)–IVC plane (Online Table 1) and at the level of the first hepatic vein (Figure 1). 3D printing the RA-IVC topography aids in transcatheter valve selection (Figure 1). CT-generated fluoroscopic images (Figure 2, Online Video 1) guided the deployment of a 30-mm self-expanding Cook Z-stent (Cook Medical Inc., Bloomington, Indiana) within the RA-IVC junction to prepare a landing zone for the 29-mm SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, California). During deployment, the 30-mm stent migrated superiorly. A second 30-mm stent was deployed lower in the IVC to anchor the scaffolding before advancing the SAPIEN XT into position. Intraprocedural transesophageal echocardiography (TEE) surveyed the right atrium for periprocedural complications (Figure 3, Online Video 2). Post-procedure gated CTA of the abdomen, and 2D echocardiogram were performed to evaluate the function and positioning of the CAVI (Figure 3, Online Video 3).
The patient was discharged 1 week post-procedure after an uncomplicated hospital stay. She subsequently had 2 repeat admissions for pleural effusions. Four-month follow-up demonstrated no recurrence of ascites or edema, with a decrease in hepatomegaly and only small pleural effusion (Figure 4).
The authors thank Christina Nelson, James Alter, and Daniel Attard of the Henry Ford Department of Radiology and Michael Forbes and Eric Myers of the Henry Ford Innovation Institute for their contributions to periprocedural planning for this case.
Drs. Guerrero and Greenbaum are proctors for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. B. O'Neill and Wang contributed equally to this work.
- American College of Cardiology Foundation