Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left panel top image: 3D intracardiac image and CT simulation demonstrating inadequate right atrial height and a deep capsule position. CT predicted adequate right atrial height of >60 mm. However, the large EV prevented adequate right atrial height and the capsule was too deep. Multiple maneuvers to gain height were insufficient from the right femoral approach, and we converted to a left femoral venous approach. Despite the left femoral approach, the capsule was still deep in the RV at 3.3 cm from the TV annulus and 2.3 cm from the systolic coaptation plane. Left panel bottom image: CT simulation demonstrating the position of the capsule in relation to the EV (∗) and the TV systolic coaptation. Right image: Capsule deep in the RV. The white interrupted line represents the approximate plane of the TV annulus. Abbreviations: A, anterior leaflet; CT, computed tomography; EV, Eustachian valve; P, posterior leaflet; RV, right ventricle; TV, tricuspid valve.

Article Snippet: After informed consent, the patient's TTVR was attempted from a right femoral approach, and a 3D Verisight intracardiac echo (ICE) (Philips, Netherlands) probe was advanced from the left femoral vein using a 12 Fr sheath due to challenging transesophageal echocardiography imaging from the mechanical aortic valve replacement.

Techniques: Computed Tomography

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left image: ICE showing the PA trajectory with the posterior aspect of the capsule edge just beneath the systolic coaptation plane. Right image: Capsule gap created with a pronounced PA trajectory to gain RA height. The white interrupted line represents the approximate plane of the TV annulus. Abbreviations: ICE, intracardiac echo; PA, posterior-to-anterior; RA, right atrium; TV, tricuspid valve.

Article Snippet: After informed consent, the patient's TTVR was attempted from a right femoral approach, and a 3D Verisight intracardiac echo (ICE) (Philips, Netherlands) probe was advanced from the left femoral vein using a 12 Fr sheath due to challenging transesophageal echocardiography imaging from the mechanical aortic valve replacement.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left image: ICE multiplanar reconstruction images. The anchors are peeking out of the capsule with a pronounced anterior trajectory and the tip of the capsule at the anterior septal commissure in the RVOT. Right image: The entire system is retracted posteriorly to avoid chordal entanglement while maintaining the anterior trajectory. Abbreviations: A, anterior; ICE, intracardiac echo; L, lateral; P, posterior; RVOT, right ventricle outflow tract; S, septal.

Article Snippet: After informed consent, the patient's TTVR was attempted from a right femoral approach, and a 3D Verisight intracardiac echo (ICE) (Philips, Netherlands) probe was advanced from the left femoral vein using a 12 Fr sheath due to challenging transesophageal echocardiography imaging from the mechanical aortic valve replacement.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Top panel: Progressive exposure of the anchors and ventricular flip of the anchors while simultaneously adding primary flex to correct the anterior trajectory and become coaxial to the TV annular plane. The white interrupted line represents the approximate plane of the TV annulus. Bottom panel: ICE multiplanar reconstruction images demonstrating the progressive ventricular flip of the EVOQUE anchors. Abbreviation: ICE, intracardiac echo; TV, tricuspid valve.

Article Snippet: After informed consent, the patient's TTVR was attempted from a right femoral approach, and a 3D Verisight intracardiac echo (ICE) (Philips, Netherlands) probe was advanced from the left femoral vein using a 12 Fr sheath due to challenging transesophageal echocardiography imaging from the mechanical aortic valve replacement.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left image: ICE image of the valve deployed. Right image: Fluoroscopy of the valve deployed. The white interrupted line represents the approximate plane of the TV annulus. Abbreviation: ICE, intracardiac echo; TV, tricuspid valve.

Article Snippet: After informed consent, the patient's TTVR was attempted from a right femoral approach, and a 3D Verisight intracardiac echo (ICE) (Philips, Netherlands) probe was advanced from the left femoral vein using a 12 Fr sheath due to challenging transesophageal echocardiography imaging from the mechanical aortic valve replacement.

Techniques: