https://doi.org/10.1007/s00392-024-02526-y
1Asklepios Klinik Wandsbek Innere Medizin Kardiologie & Pneumologie Hamburg, Deutschland; 2Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland
Introduction: The management of severe tricuspid regurgitation (TR) post-transcatheter edge-to-edge repair (T-TEER) presents a significant challenge, particularly in elderly patients with multiple comorbidities. We report a case of an 84-year-old female with severe decompensated right heart failure due to TR following previous tricuspid and mitral valve interventions.
Case Presentation: The patient initially presented with severe decompensated right heart failure secondary to torrential TR after a previous 3-device T-TEER procedure. Additionally, she had undergone a single-device mitral edge-to-edge repair (M-TEER) and atrial septal defect (ASD) closure, resulting in good long-term outcomes. Due to high operative risk, the heart team recommended a heterotopic tricuspid valve replacement using the TricValve® Transcatheter Bicaval Valves System Set (SVC 25 + IVC 31), which was performed successfully without complications.
Three months post-procedure, the patient presented to the emergency room with acute right-sided heart failure, tachycardia, atrial fibrillation, and anasarca. Imaging studies revealed cranial dislocation of the inferior vena cava (IVC) valve prosthesis into the right atrium with massive TR. Initial management included intravenous diuretic therapy and rate control of atrial fibrillation. The heart team opted for an interventional approach to anchor the dislodged 31 mm IVC prosthesis. Attempts to reposition the valve using a Swan Ganz catheter and two 5 mm non-compliant coronary balloons were unsuccessful. Consequently, a new 31 mm IVC stent valve was implanted within the dislodged valve, employing a valve-in-valve strategy.
Treatment and Outcome: Following the procedure, the IVC mean pressure acutely dropped from 16 to 11 mmHg. The patient demonstrated significant clinical improvement and was discharged in a much better condition. Follow-up transthoracic echocardiography showed no flow acceleration in the IVC and confirmed the stable position of the valve-in-valve prosthesis.
Conclusion: This case highlights the potential complications of tricuspid valve interventions, particularly valve dislocation, and underscores the necessity for vigilant long-term follow-up. The successful use of a transcatheter valve-in-valve approach in managing dislocated inferior caval TricValve® prostheses is demonstrated, providing a viable treatment strategy for similar high-risk patients.