Multimodality imaging for surgical decision-making in tricuspid regurgitation: from referral to intraoperative assessment.
4 affiliations
- 1Department of Cardiovascular Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, Mainz 55131, Germany.
- 2CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland.
- 3Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- 4Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Abstract
Tricuspid regurgitation (TR) is a clinical syndrome in which integrated multimodality imaging is central to diagnosis, timely referral, procedural selection, and assessment of treatment success. This narrative state-of-the-art review focuses on the imaging information that changes decisions along the surgical pathway while positioning surgery within contemporary transcatheter practice. Transthoracic echocardiography remains the gateway examination; three-dimensional transoesophageal echocardiography refines leaflet and annular anatomy; cardiac magnetic resonance provides the most reproducible assessment of right ventricular volumes and function; and cardiac computed tomography defines annular geometry, adjacent structures, device leads, and access. We distinguish guideline-endorsed thresholds from observational or consensus-derived decision aids and link mechanism, annular dilatation, leaflet tethering, right ventricular reserve, pulmonary haemodynamics, and end-organ risk to the choice of repair, replacement, transcatheter therapy, or surveillance. Particular emphasis is placed on perioperative imaging: the effects of anaesthesia and loading conditions, accurate septolateral annular measurement, the definition of an acceptable post-bypass result, and the significance of central vs. eccentric residual jets. A dedicated section compares imaging requirements for transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement and summarizes post-procedural surveillance. The central message is that imaging does not replace clinical judgement; it provides the shared language through which the Heart Team selects the right intervention before irreversible right-heart and end-organ damage develops.
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BibTeX
@article{ghazy2026multimodality,
title = {{Multimodality imaging for surgical decision-making in tricuspid regurgitation: from referral to intraoperative assessment.}},
author = {Ahmed Ghazy and Till Humbert and Mohamad Albitar and Hesham Elzomor and Tommaso Hinna Danesi and Ashraf Refaey and Georg Daniel Duerr and Hendrik Treede and Edoardo Zancanaro},
journal = {European heart journal. Imaging methods and practice},
year = {2026},
month = sep,
doi = {10.1093/ehjimp/qyag168},
url = {https://europepmc.org/article/MED/42948648},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Multimodality imaging for surgical decision-making in tricuspid regurgitation: from referral to intraoperative assessment.
AU - Ahmed Ghazy
AU - Till Humbert
AU - Mohamad Albitar
AU - Hesham Elzomor
AU - Tommaso Hinna Danesi
AU - Ashraf Refaey
AU - Georg Daniel Duerr
AU - Hendrik Treede
AU - Edoardo Zancanaro
PY - 2026
DA - 2026/09/29
JO - European heart journal. Imaging methods and practice
DO - 10.1093/ehjimp/qyag168
UR - https://europepmc.org/article/MED/42948648
AB - Tricuspid regurgitation (TR) is a clinical syndrome in which integrated multimodality imaging is central to diagnosis, timely referral, procedural selection, and assessment of treatment success. This narrative state-of-the-art review focuses on the imaging information that changes decisions along the surgical pathway while positioning surgery within contemporary transcatheter practice. Transthoracic echocardiography remains the gateway examination; three-dimensional transoesophageal echocardiography refines leaflet and annular anatomy; cardiac magnetic resonance provides the most reproducible assessment of right ventricular volumes and function; and cardiac computed tomography defines annular geometry, adjacent structures, device leads, and access. We distinguish guideline-endorsed thresholds from observational or consensus-derived decision aids and link mechanism, annular dilatation, leaflet tethering, right ventricular reserve, pulmonary haemodynamics, and end-organ risk to the choice of repair, replacement, transcatheter therapy, or surveillance. Particular emphasis is placed on perioperative imaging: the effects of anaesthesia and loading conditions, accurate septolateral annular measurement, the definition of an acceptable post-bypass result, and the significance of central vs. eccentric residual jets. A dedicated section compares imaging requirements for transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement and summarizes post-procedural surveillance. The central message is that imaging does not replace clinical judgement; it provides the shared language through which the Heart Team selects the right intervention before irreversible right-heart and end-organ damage develops.
SN - 2755-9637
ER -