Figure 1.

Case 1: Use of Ventilator-Assisted Valsalva Maneuver

(A) Transesophageal echocardiogram with transgastric short-axis view of the tricuspid valve showing preprocedural septolateral gaps of 0.7 to 1.0 cm (yellow arrows) (Video 1). Color Doppler 3-dimensional (3D) vena contracta area (VCA) was 1.44 cm²(B), consistent with torrential tricuspid regurgitation. Transgastric short-axis view with biplane of the tricuspid valve during transcatheter tricuspid edge-to-edge repair (T-TEER) after ventilator-assisted Valsalva maneuver, showing a reduction of the coaptation gaps to 0.3 to 0.6 cm (C) (Video 2), which can be also seen on postprocessed 3D transgastric short-axis view of the tricuspid valve (D) (Video 3). After a total of 3 T-TEER clips were placed (E), the 3D VCA was reduced to 0.13 cm²(F), consistent with mild TR. AV = aortic valve.