Tricuspid Regurgitation in the Era of Transcatheter Interventions: The Pivotal Role of Multimodality Imaging

TL;DR

This paper reviews how combining different imaging techniques improves the success of tricuspid valve interventions in high-risk patients.

Contribution

The paper highlights the pivotal role of multimodality imaging in tailoring transcatheter tricuspid valve interventions.

Findings

Transthoracic and transesophageal echocardiography are essential for initial TR assessment and patient selection.

Cardiac CT provides critical anatomical details for device sizing and procedural planning.

CMR offers precise functional and tissue assessments when echocardiography is inconclusive.

Abstract

Over the last ten years, transcatheter tricuspid valve interventions (TTVIs) have emerged as effective options for symptomatic patients with moderate-to-severe tricuspid regurgitation (TR) who are at prohibitive surgical risk. Successful application of these therapies depends on a patient-tailored, multimodal imaging workflow. Transthoracic and transesophageal echocardiography remain the first-line diagnostic tools, rapidly stratifying TR severity, mechanism, and right ventricular function, and identifying cases requiring further evaluation. Cardiac computed tomography (CT) then provides anatomical detail—quantifying tricuspid annular dimension, leaflet tethering, coronary artery course, and venous access anatomy—to refine candidacy and simulate optimal device sizing and implantation angles. In patients with suboptimal echocardiographic windows or equivocal functional data, cardiovascular magnetic resonance (CMR) offers gold-standard quantification of RV volumes, ejection fraction, regurgitant volume, and tissue characterization to detect fibrosis. Integration of echo-derived parameters, CT anatomical notes, and CMR functional assessment enables the heart team to better select patients, plan procedures, and determine the optimal timing, thereby maximizing procedural success and minimizing complications. This review describes the current strengths, limitations, and future directions of multimodality imaging in comprehensive evaluations of TTVI candidates.

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