Percutaneous Tricuspid valve repair after Mitral Valve MitraClip treatment

We present a case of a 77 y-o female with a clinical history of severe functional mitral and tricuspid regurgitation (MR, TR). In May ‘15 she undergo MitraClip treatment of MR (2 clips) and LAAo (Amplatzer amulet). Following a further episode of decompensation the percutaneous tricuspid valve repair was then planned with the TriCinch device (4Tech Cardio Ltd, Galway, Ireland). This is a percutaneous device designed for TV remodeling, by means of septolateral TV diameter reduction and leaflet coaptation restoration.

The Tricinch device implantation, performed under echocardiography and fluoroscopic guidance, consists in a transfemoral fixation of a stainless steel corkscrew into the anteroposterior TV annulus. The corkscrew is than connected through a Dacron band to a self-expanding Nitinol stent (in this specific case a 32mm stent). By pulling the system towards the inferior vena cava (IVC), the anchoring corkscrew remodeled the anteroposterior annulus, and the tension is maintained by fixation of the stent in the IVC (Figure A).

Postprocedural echocardiography showed reduced TR from 4+ to 3+ (Figure B) and 50% reduction in the effective orifice area from 2,03cm² to 1,07cm².

At latest follow-up the tension had been maintained over the TV, with improvements in tricuspid function (TR 2+) (Figure C) and clinical status (6MWT from 150m to 250m) with no other episodes of heart failure.