From Tricuspid to Mitral Valve Percutaneous Treatment

Mrs T Zehava who is 74 years suffered from sick sinus syndrome. A dual chamber pace maker was implanted in 2005. She developed progressively a right heart failure which was secondary to a severe tricuspid regurgitation; the right ventricle function was slightly decreased . The mitral regurgitation was moderate with normal left ventricle systolic function .

In 2012, she underwent an isolated surgical tricuspid replacement with Perimount valve 23 mm.

Three years later she was hospitalized for treatment of new right heart failure. Echocardiogramm showed a recurrent severe tricuspid regurgitation and depressed right ventricle function while the mitral regurgitation was moderate and preserved left ventricle function . A new surgery was considered too high risk procedure. The option of percutaneous valve in valve tricuspid implantation was proposed. The leads of the pace maker were removed and a leadless pacemaker (MICRA) was implanted into the right ventricle. Secondarily a valve Sapien 3 29 mm was implanted into the perimount valve with success through the right femoral vein. The right failure disappeared and the right ventricle function improved but the patient developed a significant shortness of breath and the mitral regurgitation per echocardiogram increased and the left ventricle function deteriorate.

A right catheterization confirm the presence of pulmonary hypertension which is post capillary. Two mitral clips were implanted in order to decrease the severity of mitral regurgitation.

The patient improved and was no more hospitalized since the last percutaneous treatment.

The development of severe mitral regurgitation after treatment of severe tricuspid regurgitation is not usual and could nowadays be treated by percutaneous treatment as much as the patient is not a good surgical candidate.