Figure 2.

Case 2: Use of PEEP and Chest Pressure

(A) Baseline preprocedural transesophageal echocardiographic transgastric short-axis view of the tricuspid valve (Video 4) shows an anteroposterior (AP) gap of 4.9 cm (red arrow), with septolateral (SL) gaps between 1.5 and 1.8 cm (yellow arrows). (B) Color Doppler 3D VCA was 3.28 cm², consistent with torrential tricuspid regurgitation. (C,D) During T-TEER, transgastric short-axis view and postprocessed 3D short-axis view of the tricuspid valve after the use of positive end-expiratory pressure (PEEP) and chest pressure show a reduction of the coaptation gaps to 0.5 to 0.7 cm (yellow arrows) (Video 5). After successful T-TEER with 2 devices (E), the 3D VCA was reduced to 1.5 cm²(F), a >50% reduction from baseline. RA = right atrium; RV = right ventricle; other abbreviations as in Figure 1.