Staubach Stephan, Sailer Michael, Koch Johannes, Maier Anatol, Jeron Andreas
Department of Cardiology, Rems-Murr-Klinikum Winnenden, Am Jakobsweg 1, 71364 Winnenden, Germany.
Eur Heart J Case Rep. 2024 Feb 21;8(3):ytae074. doi: 10.1093/ehjcr/ytae074. eCollection 2024 Mar.
We report a case of a 72-year-old patient developing a significant tricuspid regurgitation (TR) 6 years after a left ventricular assist device (LVAD) implantation. The aim of this case is to demonstrate the feasibility of transcatheter edge-to-edge repair (TEER) of the tricuspid valve and the excellent clinical benefit in long-term follow-up in an LVAD patient.
Our patient presented with recurrent acute heart failure syndrome. After a fulminant myocarditis in 2005, his previous treatment consisted of cardiac resynchronization therapy, TEER of the mitral valve, and LVAD (HeartMate III) implantation. At that point in time, his TR was only mild to moderate. Due to recurrent hospitalization despite optimized heart failure medication, we decided to treat the patient with a tricuspid TEER. His immediate post-interventional result and 1-year follow-up showed an excellent outcome with only minimal TR on transoesophageal echocardiogram.
In general, TR improves after LVAD implantation. However, there are two possible pathophysiological mechanisms, which result in an increasing TR: firstly, supporting LV dysfunction may lead to a leftward shift of the interventricular septum with restriction of the tricuspid leaflets. Secondly, the increase of venous preload with LVAD support may result in an annular dilatation with secondary TR, particularly in patients with pre-existing right ventricular dysfunction. According to the data currently available, the unpredictable course of developing TR necessitates regular clinical examination and echocardiographic investigation. Treatment with TEER appears to be feasible and safe, with excellent 1-year results in patients with previously implanted LVADs.
我们报告一例72岁患者在植入左心室辅助装置（LVAD）6年后出现严重三尖瓣反流（TR）的病例。本病例的目的是证明经导管缘对缘修复（TEER）三尖瓣的可行性以及在LVAD患者长期随访中的显著临床益处。
我们的患者出现复发性急性心力衰竭综合征。2005年患暴发性心肌炎后，他之前接受过心脏再同步治疗、二尖瓣TEER和LVAD（HeartMate III）植入。当时，他的TR仅为轻度至中度。尽管优化了心力衰竭药物治疗，但由于反复住院，我们决定对该患者进行三尖瓣TEER治疗。他介入后的即时结果和1年随访显示效果极佳，经食管超声心动图显示仅有轻微TR。
一般来说，LVAD植入后TR会改善。然而，有两种可能的病理生理机制会导致TR增加：首先，支持左心室功能障碍可能导致室间隔向左移位，限制三尖瓣叶活动。其次，LVAD支持下静脉前负荷增加可能导致瓣环扩张并继发TR，特别是在已有右心室功能障碍的患者中。根据目前可用的数据，TR发展过程不可预测，因此需要定期进行临床检查和超声心动图检查。TEER治疗似乎可行且安全，对于先前植入LVAD的患者，1年结果良好。
