Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation

Mangieri, Antonio; Pagnesi, Matteo; Regazzoli, Damiano; Laricchia, Alessandra; Ho, Edwin; Goldberg, Ythan; Chau, Mei; Gallo, Francesco; Fisicaro, Andrea; Khokhar, Arif; Colombo, Antonio; Giannini, Francesco; Latib, Azeem

doi:10.3389/fcvm.2020.581211

Cited by 12 publications

(6 citation statements)

References 44 publications

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“…Due to the high prevalence of significant TR with increasing age, many patients are further deemed as high surgical risk, leaving most of them without any other choices than conservative therapy. Thankfully, recent advancements in percutaneous technologies have created novel perspectives, but are yet lacking sufficient data to support their widespread use [ 6 ]. One of these emerging devices is the TriClip ® system, a leaflet plasty device used for reducing TR by either creating a triple-orifice or a bicuspidalized valve [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Edge-to-Edge Tricuspid Valve Repair in a Patient with Cor Triatriatum Dexter: A Case Report

Barbieri

Schröder

Beyhoff

et al. 2021

JCDD

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Background: Tricuspid regurgitation is gaining importance due to its high morbidity and mortality. Especially in the elderly, novel technologies in percutaneous therapies have become valuable options due to the commonly present high surgical risk. Case presentation: We report a case of a 78-year-old female suffering from massive tricuspid regurgitation with repetitive right-sided heart failure hospitalizations. As the patient was very frail and deemed as high surgical risk, we used the TriClip® system to improve her symptomatic status. During diagnostic work-up, an additional membrane separating the right atrium, consistent with the definition of a cor triatriatum dexter, was found. Although increasing the complexity of the procedure, implantation of 3 clips with reduction of tricuspid regurgitation to a mild-to-moderate degree was achieved without any notable complications. The patient was discharged with ameliorated symptoms on the fourth postoperative day. Conclusions: Our case highlights the feasibility of percutaneous edge-to-edge tricuspid valve repair in an elderly woman with cor triatriatum dexter. Accurate echocardiographic visualization is an absolute requirement to gain access to the tricuspid valve without interacting with prevailing additional membranes.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Edge-to-Edge Tricuspid Valve Repair in a Patient with Cor Triatriatum Dexter: A Case Report

Barbieri

Schröder

Beyhoff

et al. 2021

JCDD

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“…Although indications for surgical treatment of secondary tricuspid regurgitation are clearly stated in current guidelines, 9,10 isolated tricuspid valve surgery is associated with high mortality 11–13 . New transcatheter options have been developed during recent years for the percutaneous treatment of tricuspid regurgitation 14 . The randomized trial to Evaluate Cardiovascular Outcomes in Patients Treated with the Tricuspid Valve Repair System Pivotal (TRILUMINATE Pivotal) has recently demonstrated that tricuspid transcatheter edge-to-edge repair (TEER) was safe in patients with severe tricuspid regurgitation and, as compared with medical therapy, reduced tricuspid regurgitation severity and improved quality of life, although mortality and heart failure hospitalization were similar between the TEER and control groups.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] New transcatheter options have been developed during recent years for the percutaneous treatment of tricuspid regurgitation. 14 The randomized trial to Evaluate Cardiovascular Outcomes in Patients Treated with the Tricuspid Valve Repair System Pivotal (TRILU-MINATE Pivotal) has recently demonstrated that tricuspid transcatheter edge-to-edge repair (TEER) was safe in patients with severe tricuspid regurgitation and, as compared with medical therapy, reduced tricuspid regurgitation severity and improved quality of life, although mortality and heart failure hospitalization were similar between the TEER and control groups. However, the rate of clinical events was lower than expected in both arms probably because of the low-risk profile of the included population.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure

Pagnesi,

Riccardi,

Chiarito

et al. 2024

Journal of Cardiovascular Medicine

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Aims To evaluate the role of tricuspid regurgitation in advanced heart failure. Methods The multicenter observational HELP-HF registry enrolled consecutive patients with heart failure and at least one ‘I NEED HELP’ criterion evaluated at four Italian centers between January 2020 and November 2021. Patients with no data on tricuspid regurgitation and/or receiving tricuspid valve intervention during follow-up were excluded. The population was stratified by no/mild tricuspid regurgitation vs. moderate tricuspid regurgitation vs. severe tricuspid regurgitation. Variables independently associated with tricuspid regurgitation, as well as the association between tricuspid regurgitation and clinical outcomes were investigated. The primary outcome was all-cause mortality. Results Among the 1085 patients included in this study, 508 (46.8%) had no/mild tricuspid regurgitation, 373 (34.4%) had moderate tricuspid regurgitation and 204 (18.8%) had severe tricuspid regurgitation. History of atrial fibrillation, any prior valve surgery, high dose of furosemide, preserved left ventricular ejection fraction, moderate/severe mitral regurgitation and pulmonary hypertension were found to be independently associated with an increased likelihood of severe tricuspid regurgitation. Estimated rates of 1-year all-cause death were of 21.4, 24.5 and 37.1% in no/mild tricuspid regurgitation, moderate tricuspid regurgitation and severe tricuspid regurgitation, respectively (log-rank P < 0.001). As compared with nonsevere tricuspid regurgitation, severe tricuspid regurgitation was independently associated with a higher risk of all-cause mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.01–1.88, P = 0.042), whereas moderate tricuspid regurgitation did not. Conclusion In a contemporary, real-world cohort of patients with advanced heart failure, several clinical and echocardiographic characteristics are associated with an increased likelihood of severe tricuspid regurgitation. Patients with severe tricuspid regurgitation have an increased risk of mortality.

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“…The cor triatriatum dexter membrane can be identified by TTE, TEE, cardiac CTA, or cardiac MRI [8,9]. The association of incomplete cor triatriatum dexter membrane and a sinus venosus ASD is very rare, and makes the percutaneous closure of ASD [8][9][10] and the percutaneous treatment of tricuspid valve regurgitation [11,12] very challenging.…”

Section: Introductionmentioning

confidence: 99%

Cor Triatriatum Dexter With a Sinus Venosus Atrial Septal Defect in a 50-Year-Old Woman: A Case Report

Kazma,

Fakih,

Raad

et al. 2024

Cureus

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The diagnosis of atrial septal defect (ASD) may be delayed until adulthood or even later in life as it is a well-tolerated congenital heart disease. If patients are not examined and investigated well in childhood, the diagnosis may be delayed until later in adulthood when patients present with palpitations and sometimes dyspnea due to the right chambers dilatation from right ventricular volume overload. In this report, we present a case of a 50-year-old female patient with symptoms of heart failure and atrial fibrillation who was found to have dilated right cardiac chambers, dilated pulmonary artery, severe tricuspid regurgitation, pulmonary hypertension, and a pulmonary-to-systemic flow ratio (Qp/Qs) of more than 1.5 by transthoracic echocardiography and Doppler, indicating left to right shunt at the atrial level. However, transthoracic echocardiography could not visualize the defect, and two-dimensional (2D) transesophageal echocardiography was done in this patient and documented the presence of a sinus venosus ASD with an incomplete cor triatriatum dexter membrane; all four pulmonary veins were identified going to the left atrium. Since the presence of an incomplete cor triatriatum dexter membrane (despite causing no symptoms) makes the percutaneous closure of the sinus venosus ASD and the percutaneous repair of tricuspid regurgitation very difficult, we decided to advise surgical ASD closure and tricuspid valve repair for the patient.

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Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation

Cited by 12 publications

References 44 publications

Percutaneous Edge-to-Edge Tricuspid Valve Repair in a Patient with Cor Triatriatum Dexter: A Case Report

Percutaneous Edge-to-Edge Tricuspid Valve Repair in a Patient with Cor Triatriatum Dexter: A Case Report

Characteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure

Cor Triatriatum Dexter With a Sinus Venosus Atrial Septal Defect in a 50-Year-Old Woman: A Case Report

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