Welcome to the opening chapter of ICE and TEE Guidance for TriClip Tricuspid TEER. Dr Karim Al-Azizi (Baylor Scott & White Health – The Heart Hospital, US) presents a compelling real-world case of an 80‑year‑old frail woman with severe, symptomatic pacemaker lead–related tricuspid regurgitation and heart failure with preserved ejection fraction (HFpEF). Despite optimised medical therapy, the patient remained significantly symptomatic.

Dr Al-Azizi offers detailed insights into case planning, patient selection, and the rationale for adopting a hybrid imaging strategy in this complex clinical setting. This step-by-step walkthrough provides valuable practical guidance for interventional and imaging cardiologists managing advanced tricuspid valve disease.
 

Key learning points:

• Patient selection and risk assessment: Structuring a comprehensive evaluation for TriClip tricuspid transcatheter edge‑to‑edge repair (TEER) in frail, high‑risk patients with pacemaker lead–related tricuspid regurgitation.
• Hybrid imaging protocol: Implementing a reproducible transoesophageal (TEE) and intracardiac (ICE) echocardiography–based imaging algorithm for procedural planning and real‑time guidance.
• Imaging‑driven intervention strategy: Using an imaging‑guided approach to target a precise two‑clip TriClip repair aimed at optimising symptomatic improvement.

Heart Team:

Surgeon: Dr Karim Al-Azizi
Imaging: Dr Ralph Matar
Anaesthesiologist: Dr Jason Evan Smith
Co-surgeon: Dr Lee Hafen
Fellow: Dr Ahmed Elkaialy

Institution: Baylor Scott & White Health – The Heart Hospital, Plano, US

Imaging and Procedural Systems:

• Intracardiac Echocardiography System: Philips Healthcare
• Transcatheter Tricuspid Repair Device: TriClip (Abbott Structural Heart)
• Transoesophageal Echocardiography: Philips Healthcare
• Fluoroscopy Guidance System: Standard equipment

Producer: Transcatheter Academy
Editor: Mirjam Boros