Edge-to-Edge Tricuspid Valve Repair for Severe Tricuspid Regurgitation 20 Years After Cardiac Transplantation

Figure 1. Baseline transthoracic and transesophageal echocardiogram. (A) Baseline transthoracic echocardiogram showed moderate bi‐atrial enlargement, right ventricular enlargement, and moderate–severe tricuspid valve regurgitation. (B) Baseline transesophageal echocardiogram showed moderate–severe tricuspid valve regurgitation.

Figure 2. Haemodynamic tracing at baseline, peak exercise, and post tricuspid valve repair.

Figure 3. Intraprocedural transthoracic and transesophageal echocardiogram. (A, B) Apical four‐chamber with colour view demonstrating moderate–severe tricuspid regurgitation at baseline and severe tricuspid regurgitation during exercise. (C, D) Transesophageal echocardiography three‐dimensional full images of the tricuspid valve anatomy during diastole and systole demonstrating three distinct tricuspid leaflets (A; anterior, P; posterior, S; septal). (E) Transesophageal echocardiography multiplanar reconstruction images of the tricuspid valve in diastole demonstrating anterior and septal leaflet lengths are adequate for edge‐to‐edge repair without excessive chordal bundles present. (F) Three‐dimensional colour images demonstrating the primary jet of tricuspid regurgitation is between the anterior and septal leaflets.

Figure 4. Percutaneous edge‐to‐edge tricuspid valve repair. (A) MitraClip was deployed between anterior and septal leaflets. A, anterior; S, septal; P, posterior; white arrow, MitraClip device. (B) Tricuspid regurgitation was decreased to mild range after successful tricuspid valve repair.