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

Abstract

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.

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

“…The presence of an incomplete cor triatriatum dexter membrane, despite being an innocent bystander, made the percutaneous treatment for this patient very challenging: closure of the sinus venosus ASD and repair of the tricuspid valve regurgitation [ 9 ]. Some have tried dilatation of the cor triatriatum dexter membrane during closure of ASD [ 8 ]; others have done percutaneous edge-to-edge tricuspid valve repair in a patient with cor triatriatum dexter [ 12 ], so our patient was advised surgery despite the fact that she was at increased risk due to her previous head gunshot wound injury and residual neurologic deficit. The patient was referred to a facility where onsite cardiac surgery was available, and she would undergo further investigation including cardiac CTA, cardiac MRI, and further testing regarding her pulmonary hypertension (looking at reversibility of pulmonary hypertension) before surgery.…”

“…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.…”

Fetal 3d-Echo Classification and Segmentation Using Color and Textural Features for Tr Detection

“…TR is a common valve heart condition that develops with age, regardless of gender. Significant TR is expected to affect up to 2.7 % of patients, with the elderly being the most sensitive [1]. The tricuspid valve controls blood flow between the right atrium and the right ventricle.…”