Extract

The novel MitraClip XTR device has significantly longer clip arms compared with its predecessor to simplify leaflet grasping (Panel A). We applied it to treat a patient with severe secondary tricuspid regurgitation (TR). The patient (female, 57 years) had undergone lung transplantation for idiopathic pulmonary arterial hypertension and subsequent MitraClip NTR implantation for severe mitral regurgitation 8 years ago. Echocardiography revealed mild mitral regurgitation, on invasive assessment mean pulmonary artery pressure was 24 mmHg. She presented with severe symptoms [New York Heart Association (NYHA) Class III] and recurrent peripheral oedema despite maximal diuretic therapy.

The XTR clip was placed to connect the septal and the anterior leaflet at the point of maximum regurgitant flow. A second Clip (NTR) was placed next to the first one for stabilization. The tricuspid annular diameter was reduced from 41–43 mm (Panels B and C) to 27–31 mm (Panels F and G). Accordingly, the effective regurgitant orifice area (EROA) decreased from 160 mm2 to 31 mm2 (Panels D and H) and the tricuspid perimeter decreased from 21.1 cm to 12.1 cm (Panels E and I; Supplementary material online, Video 1). At 4-month follow-up, the patient had significantly improved (NYHA Class II and mild TR).

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