Concomitant transcatheter edge-to-edge treatment for mitral regurgitation and the K-Clip system for tricuspid regurgitation: one case report

Figures

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  Figure 1. (A) The coronary CTA: the distance between the RCA and the tricuspid annulus is all greater than 3.0 mm. (B) After the tricuspid annuloplasty re-examination of right coronary angiography: TIMI grade 3 blood flow.

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  Figure 2. Pre- and post-operation images of the mitral TEER. (A,E) MR was reduced from severe(4+) to mild(1+) during systole in 2-dimensional TEE. (B,F) Position of the mitral valve clip under fluoroscopy. (C,G) Mitral valve morphology during systole in 3-dimensional TEE. (D,H) MR was reduced from severe(4+) to mild(1+) during systole 3-dimensional TEE-color flow.

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  Figure 3. Pre- and post-annuloplasty images of the K-Clip tricuspid system. (A,F) TR was reduced from severe(4+) to mild(1+) during systole in 2-dimensional TEE. (B,G) Position of the tricuspid valve clip under fluoroscopy, (C) Anchor point 1: the junction of the posterior and septal leaflets, (H) Anchor point 2: the junction of the anterior and posterior leaflets; (D,I) Tricuspid valve morphology during systole in 3-dimensional TEE, (E,J) TR was reduced from severe(4+) to mild(1+) during systole in 3-dimensional TEE-color flow.

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  Figure 4. A timeline with relevant data from the episode of care.

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  Figure 5. K-Clip® system. (A) K-Clip® system comprises two clip arms and a central anchoring screw, forming a “clip arm–annulus–screw sandwich” structure. Four clip sizes (arm length 36, 42, 48, 54Fr) are available. (B) K-Clip® operating Steps. Step 1: Through the jugular vein approach, enter the right atrium and adjust the delivery system to point towards the tricuspid annulus. Step 2: Drive the anchoring component into the target point on the annulus. Step 3: Adjust the grasping arms onto the annulus and gently lift the tissue. Step 4: Close the grasping arms to form a stable sandwich structure. Step 5: Detach the annuloplasty device and retract the delivery system. Step 6: After detachment, endothelialization occurs and the structure integrates as one.