O'Sullivan Sina, Reddy Prajwal, Parikh Pragnesh, El Sabbagh Abdallah, Pollak Peter
Department of Cardiology, Mayo Clinic Florida, Jacksonville, Florida, USA.
Department of Cardiology, Mayo Clinic Florida, Jacksonville, Florida, USA.
JACC Case Rep. 2025 Jun 4;30(13):103864. doi: 10.1016/j.jaccas.2025.103864.
Single leaflet device attachment (SLDA) during transcatheter edge-to-edge repair (TEER) of the tricuspid valve is an uncommon but recognized complication. This case series presents 2 older adult patients with symptomatic severe tricuspid regurgitation who underwent tricuspid TEER and experienced SLDA during the procedure.
The first patient was an 85-year-old man with liver cirrhosis and right-sided heart failure. Transthoracic echocardiography (TTE) revealed severe tricuspid regurgitation secondary to annular dilation, with a coaptation gap of 5 mm between the anterior and septal leaflets. He was deemed a high operative risk and underwent tricuspid TEER (tTEER) using 2 MitraClip XTW devices (Abbott). During the procedure, 1 clip detached from the septal leaflet and was retrieved using EN Snare (Merit Medical) and ŌNŌ (ŌNŌ COR) devices, with placement of another clip. The procedure ultimately reduced tricuspid regurgitation from massive to moderate. The second patient was a 70-year-old woman with a history of atrial fibrillation and rheumatoid arthritis. She presented with symptomatic severe secondary tricuspid regurgitation on both TTE and transesophageal echocardiography. The tTEER procedure was performed using a XTW TriClip (Abbott). Following SLDA, the clip was retrieved using the EN Snare and ŌNŌ devices, and 2 subsequent clips were placed successfully, thus reducing regurgitation to mild.
SLDA during tTEER presents a significant procedural challenge but can be managed effectively with clip retrieval using the EN Snare and ŌNŌ devices. Both cases demonstrated successful clip retrieval without injury to the valve leaflets and successful TEER.
在经导管三尖瓣边缘对边缘修复术（TEER）期间，单瓣叶装置附着（SLDA）是一种罕见但已被认识到的并发症。本病例系列介绍了2例有症状的严重三尖瓣反流的老年患者，他们接受了三尖瓣TEER手术，并在手术过程中发生了SLDA。
首例患者为一名85岁男性，患有肝硬化和右心衰竭。经胸超声心动图（TTE）显示继发于瓣环扩张的严重三尖瓣反流，前叶和隔叶之间的对合间隙为5mm。他被认为手术风险高，使用2个MitraClip XTW装置（雅培公司）进行了三尖瓣TEER（tTEER）。手术过程中，1个夹子从隔叶脱落，使用EN圈套器（美力医疗公司）和ŌNŌ（ŌNŌ COR公司）装置将其取出，并放置了另一个夹子。该手术最终将三尖瓣反流从大量减少至中度。第二例患者为一名70岁女性，有房颤和类风湿关节炎病史。她在TTE和经食管超声心动图检查中均表现为有症状的严重继发性三尖瓣反流。使用XTW TriClip（雅培公司）进行了tTEER手术。发生SLDA后，使用EN圈套器和ŌNŌ装置取出夹子，并成功放置了2个后续夹子，从而将反流减少至轻度。
tTEER期间的SLDA带来了重大的手术挑战，但使用EN圈套器和ŌNŌ装置取出夹子可有效应对。两例均成功取出夹子，未损伤瓣膜小叶，且TEER手术成功。
