Figure 3.
Case 3: Use of PEEP
(A) Baseline transgastric short-axis view shows a septolateral gap of 0.38 cm with dense chordae. (B) Tricuspid valve leaflets close at the annular plane (midesophageal RV inflow view with biplane) with a relatively short septal leaflet. (C) Color Doppler 3D VCA was 0.75 cm2, consistent with severe tricuspid regurgitation (TR). (D) During T-TEER, after the anterior leaflet was grasped, the device could not be maneuvered close enough to the septum for an adequate grasp of the septal leaflet (midesophageal RV inflow view with biplane) (Video 6). (E) PEEP was used to reduce the tricuspid annular (TA) diameter (green arrows) (Video 7). (F) After single-device T-TEER, the 3D VCA was reduced to 0.15 cm2, consistent with mild TR. Abbreviations as in Figures 1 and 2.