Tricuspid regurgitation (TR) is a prevalent and progressive condition associated with heart failure symptoms; however, numerous patients are unsuitable for surgery, and achieving a long-term outcome is challenging. This renders TR an unmet clinical problem. Computational modeling facilitates the evaluation of the biomechanics associated with regurgitation, aiming to enhance therapeutic strategies as transcatheter edge-to-edge repair. This study sought to establish a computational framework integrating a tricuspid valve (TV) model with the right ventricle (RV) wall to evaluate native valve function, TR pathology, and repair using the MitraClip device. Computed tomography angiography (CTA) from three patients was utilized to reconstruct the tricuspid valve leaflets, annulus, and RV wall. A parametric CAD pipeline for modeling the leaflet surfaces and chordal architecture was built using ex-vivo data. Annular kinematics (systole-to-diastole) were computed and then applied as a boundary condition in the finite-element analyses, with tricuspid regurgitation induced by displacing papillary positions and augmenting transvalvular loading. The MitraClip deployment was subsequently simulated whereas the post-deformation hemodynamics were assessed using a lattice-Boltzmann solver to quantify intraventricular velocity fields and vorticity. All three models demonstrated physiological leaflet coaptation and stress distributions in a healthy patient condition, with maximum stresses at end-systole quantified in the leaflet belly and chordal insertions. Post-MitraClip simulations demonstrated restored valve closure without retrograde flow during systole; however, flow exhibited a double-orifice inflow and localized vorticity near the clip during diastole. The jet orientation and downstream patterns depended on patient anatomy. This computational framework replicates TV biomechanics and post-repair hemodynamics from standard imaging, facilitating quantitative, patient-specific evaluation. The current patient-specific, image-based computational method can predict TV-related performance and post-repair hemodynamic outcomes, facilitating personalized planning to minimize residual TR and enhance device placement.

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac anomaly, commonly associated with tetralogy of Fallot (TOF). Non-TOF variant, APVS with intact ventricular septum (IVS) and patent ductus arteriosus (PDA) are infrequently reported. While airway compression is a well-known complication, hemodynamic compromise with circular shunting is extremely rare. A full-term neonate with prenatally diagnosed APVS and IVS presented with severe pulmonary stenosis, pulmonary regurgitation (PR), tricuspid regurgitation (TR), and a large PDA. On the 3[rd] day of life, the infant developed respiratory distress and systemic hypoperfusion. Echocardiography revealed a circular shunt comprising severe PR and TR, right-to-left shunting at the atrial level, and left-to-right ductal flow. Emergent PDA ligation resulted in rapid hemodynamic recovery. The infant remained well at the 8-month follow-up. This appears to be the first reported case of circular shunting in APVS and intact IVS, emphasizing the need for vigilance and timely surgical intervention.

Pectus excavatum can rarely result in clinically significant right ventricular (RV) compression, leading to impaired diastolic filling, reduced stroke volume, and secondary biventricular dysfunction involving both the right and left ventricles. We report a 19-year-old male who presented with progressive exertional dyspnea and was found to have severe pectus excavatum with a Haller index of 5.8 on cardiac magnetic resonance imaging and 3.6 on computed tomography. Multimodal cardiac evaluation demonstrated focal RV compression, moderate RV systolic dysfunction on cardiac MRI with a right ventricular ejection fraction (RVEF) of 31%, mild left ventricular (LV) systolic dysfunction with an ejection fraction of 44%-45%, and trivial mitral and tricuspid regurgitation. Spirometry was overall normal, without obstructive changes or exercise-associated bronchoconstriction, and electrocardiography revealed marked right-axis deviation. Coronary computed tomography angiography demonstrated normal coronary anatomy, while cardiac MRI showed no delayed gadolinium enhancement to suggest myocardial scar or infiltrative cardiomyopathy. In the absence of alternative clinical or imaging evidence for another cardiomyopathic process, the patient met morphologic and physiologic criteria for surgical repair and underwent minimally invasive correction with pectus bar placement without complication. At five-month follow-up, he reported resolution of dyspnea, although repeat postoperative cardiac imaging had not yet been performed. This case emphasizes the importance of recognizing extrinsic RV compression from pectus excavatum as a surgically correctable and likely reversible contributor to ventricular dysfunction and highlights the role of comprehensive imaging in guiding timely surgical intervention.

Advancements in transcatheter tricuspid valve intervention (TTVI) technology have yielded meaningful improvements in quality-of-life (QOL) for patients with tricuspid regurgitation (TR). The recent Food and Drug Administration (FDA) approval of two TTVI devices, TriClip and EVOQUE, has prompted extensive discussion regarding patient selection, device preference, and optimal timing of intervention. A dedicated session titled "Beyond the Guidelines: Tricuspid repair, replacement, medical therapy" was convened to examine clinical scenarios not adequately addressed by existing guidelines. This review summarizes the key observations and expert panel discussion to identify evidence gaps and inform the framework for future guideline development.

Double-chambered right ventricle (DCRV) is defined as the progressive division of the right ventricle into two chambers: a high-pressure inlet chamber and a low-pressure outlet chamber. To date, only three cases diagnosed prenatally have been reported in the literature, all of which were associated with unfavorable pregnancy outcomes. In this study, we discuss DCRV in general, along with two cases of type 1 DCRV that did not cause hemodynamically significant obstruction and resulted in successful pregnancy outcomes. From a hemodynamic perspective, the following echocardiographic criteria may affect the prenatal fetal process: (1) detection of tricuspid regurgitation on echocardiography; and (2) pulmonary blood flow velocity and the difference in pressure between the proximal and distal right ventricle.