Clipping of the tricuspid valve: proposal of a "Rosetta Stone" nomenclature for procedural 3D transoesophageal guidance.

Abstract

Although preliminary experience has shown the feasibility of tricuspid valve clipping, intraprocedural guidance remains a major issue. The aim of this report is to provide a simple nomenclature for intra-procedural 3D TEE guidance during transcatheter tricuspid valve interventions. The identification of the location of the aortic valve (AV) is fundamental to understanding the orientation of the leaflets: the leaflet opposite the AV is the posterior leaflet (P). Anterior (A) and septal (S) leaflets are easily identified counterclockwise. The movements of the guiding catheter in the right atrium can be divided for orientation: towards the AV ("Aortic" direction) or towards the posterior leaflet ("Posterior" direction); the movement perpendicular to the previous one can be towards the anterior ("Anterior" direction) or towards the septal leaflet ("Septal" direction). We have provided a simple nomenclature, which can be shared between the person performing the procedure and the person who is guiding, that could serve as a "Rosetta Stone" for TV clipping, and for transcatheter TV interventions in general.