https://orcid.org/0000-0002-6723-005X
A 78-year-old female patient was admitted to our institution with signs of right heart failure. Transthoracic echocardiography (TTE) after recompensation was unremarkable except for torrential tricuspid regurgitation (TR) with concomitant right ventricular (RV) dilatation and poor RV systolic function (Panel F, Supplementary data online, Video S1). The patient had a history of paroxysmal atrial fibrillation and carried a dual-chamber pacemaker for sick sinus syndrome.
To elucidate potential causes of TR, left- and right heart catheterization was performed revealing normal coronaries and slightly elevated pulmonary pressures. The patient was considered not amendable for tricuspid valve surgery due to high surgical risk and frailty. She was evaluated for a transcatheter coaptation/annuloplasty device; however, due to the position of the pacemaker lead and poor transoesophageal imaging quality, she was not a candidate. As a last option, we offered her a transcatheter TricValve® implantation. The device consists of two self-expanding bovine pericardial valves (Panels A and B), which have to be implanted in the superior and inferior vena cava (SVC and IVC, RA indicates right atrium, Panel C). From a right-femoral access, the valves were successfully deployed under fluoroscopic guidance (Panel D), using also CT fusion imaging for exact positioning (Panel E).
The patient was discharged 3 days after the procedure. At 3 months, her symptoms and exercise capacity had significantly improved. On TTE, TR had decreased from torrential to mild-to-moderate (Panel G, Supplementary data online, Video S2).
This case demonstrates a new interventional treatment option for patients with severe TR not suitable for transcatheter coaptation/annuloplasty devices.
Panels A–C are published with license of P + F Products&Features GmbH.
Data availabilty: The data underlying this article will be shared on reasonable request to the corresponding author.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
