Dynamic improvement of tricuspid valve leaflets coaptation and tricuspid regurgitation without surgical treatment: a case report

Background: Tricuspid regurgitation is a prevalent condition among patients with heart failure. Functional tricuspid regurgitation arises from multiple contributing factors, and tricuspid regurgitation severity is sensitive to changes in volume status. Importantly, significant tricuspid regurgitation is associated with adverse outcomes; therefore, tricuspid regurgitation management is crucial. Case summary: We describe the case of a 92-year-old man was diagnosed with decompensated heart failure with underlying reduced ejection fraction, multivessel coronary artery disease, low-flow low-gradient aortic stenosis, atrial flutter, and severe tricuspid regurgitation without leaflet coaptation. Owing to the high surgical risk, a minimally invasive treatment strategy was adopted. The patient underwent percutaneous coronary intervention of the left coronary artery, including the left main coronary artery, after which sinus rhythm was spontaneously restored. However, the severity of tricuspid regurgitation remained unchanged posttreatment. Thus, transcatheter aortic valve implantation was subsequently performed. Remarkably, echocardiography on the day after transcatheter aortic valve implantation revealed an improvement in tricuspid regurgitation severity from severe to moderate, with leaflet coaptation and size reduction of the right atrium and right ventricle. Discussion: This case highlights that severe tricuspid regurgitation, even without leaflet coaptation, can be improved through comprehensive management of ischaemia, valvular heart disease, and arrhythmia in the absence of surgical treatment. This treatment approach may offer clinical benefits to patients at high surgical risk.