Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Radiation-induced tricuspid regurgitation and pericardial constriction (n=1). Intervention: Transcatheter edge-to-edge valve repair (TEER). Primary outcome: Hemodynamic changes and clinical improvement.

Katie P. Truong; Marcella Calfon Press; Peyman Benharash; Saibal Kar; Norman E. Lepor; Gabriel Vorobiof; Eric H. Yang

doi:10.1161/circheartfailure.122.010170

September 13, 2023Circulation Heart FailureOpen Access

Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair

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Key result

TEER for radiation-induced severe TR unmasks pericardial constriction but enables 5-year survival.

n=1

Key Points

To describe the hemodynamic effects and clinical feasibility of transcatheter edge-to-edge tricuspid valve repair in a patient with concomitant radiation-induced tricuspid regurgitation and constrictive pericarditis.
Evaluated a 67-year-old female presenting with cardiogenic shock, severe tricuspid regurgitation, and prior chest radiotherapy estimated at 120 Gy.
Stabilized cardiogenic shock with venoarterial extracorporeal membrane oxygenation followed by successful decannulation on hospital day 22.
Delivered two transcatheter clips between the posterior and septal tricuspid valve leaflets under echocardiographic and invasive hemodynamic guidance.
Transcatheter edge-to-edge repair reduced severe tricuspid regurgitation to residual mild regurgitation, resulting in improved renal function.
Post-procedure hemodynamics demonstrated an elevation of right-sided pressures and pulmonary capillary wedge pressure, unmasking underlying constrictive physiology.
The patient was discharged on hospital day 32 at New York Heart Association Class II functional status and remained stable on oral diuretics at 5 years.

Study Design

Type

Case Report (n=1)

Multicenter

No

PICO

P

Population

A 67-year-old female with radiation-induced severe tricuspid regurgitation and pericardial constriction who underwent transcatheter tricuspid valve repair.

I

Intervention / Comparator

Transcatheter edge-to-edge valve repair (TEER) (2 clips)

O

Primary Outcome

Hemodynamic changes and clinical improvement

Limitations

Single case report
Evaluating for pericardial constriction in the setting of severe tricuspid regurgitation can be difficult to ascertain

Implication

Case report reveals feasibility of transcatheter edge-to-edge tricuspid repair in radiation heart disease, indicating repair may unmask occult pericardial constriction.

Abstract

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Discussion

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Cite This Study

Truong et al. (2023) conducted a case report in Radiation-induced tricuspid regurgitation and pericardial constriction (n=1). Transcatheter edge-to-edge valve repair (TEER) was evaluated on Hemodynamic changes and clinical improvement. Transcatheter edge-to-edge tricuspid valve repair in a patient with radiation-induced severe tricuspid regurgitation unmasked underlying pericardial constriction but ultimately led to clinical stabilization and survival at 5 years.

synapsesocial.com/papers/6a7164e4fe4101aa97e08e61 https://doi.org/10.1161/circheartfailure.122.010170

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Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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