Computed Tomography Assessment of the Tricuspid Valve and the Right Heart

With advances in the management of heart failure, patients are living longer and into more advanced stages of their disease process. Left ventricular dysfunction along with pulmonary hypertension and congenital heart disease can lead to eventual right ventricular dysfunction and dilation. Right ventricular dilation leads to tricuspid annular dilation and ultimately tricuspid regurgitation. There is a growing body of evidence for poor outcomes in patients with right ventricular dysfunction and tricuspid regurgitation. These trends have coincided with the advent of clinical trials for numerous transcatheter tricuspid valve repair and replacement systems. Thus, a thorough assessment of the right ventricle and the right-sided structures, including the tricuspid valve, has become crucial. Echocardiography has limitations in evaluation of the right-sided structures due to the complex geometry of the right heart and limited acoustic windows. Cardiac magnetic resonance imaging is considered the current standard for right heart imaging evaluation; however, it has limitations, including cost, accessibility, and the presence of implantable cardiac devices. Computed tomography (CT) has emerged as an effective imaging modality to evaluate cardiac structure and function both for left heart and right heart due to its superior spatial resolution and ever-improving temporal resolution on modern CT scanners. Accurate assessment of right ventricular structure and function as well as detailed evaluation of the structure of the tricuspid annulus, inferior vena cava, and superior vena cava can be achieved using specific CT imaging protocols. Computed tomography is also playing an important role in patient selection for emerging transcatheter tricuspid valve interventions.