Resolution of Lancisi’s sign following bicaval TricValve implantation for torrential tricuspid regurgitation: a case report defining a novel bedside marker of haemodynamic recovery

Caval valve implantation (CAVI) using the TricValve system is an emerging treatment option for severe tricuspid regurgitation (TR) in patients who are unsuitable for surgery or orthotopic transcatheter intervention. Lancisi's sign is a classical manifestation of severe TR; however, its resolution after CAVI has not been described.

An 85-year-old woman with recurrent right heart failure and torrential TR presented with prominent bilateral Lancisi's sign. Echocardiography revealed severe annular dilatation (48 mm), right ventricular dysfunction (TAPSE, 13 mm), and a left ventricular ejection fraction of 40%. Owing to prohibitive surgical risk (EuroSCORE II 18.4%; TRI SCORE 14), she underwent successful implantation of 29-mm superior vena cava and 35-mm inferior vena cava TricValve prostheses. At 3 months, Lancisi's sign had completely resolved, NYHA functional class improved from III-IV to I-II, NT-proBNP decreased from 25 000 to 2 000 pg/mL, TAPSE increased from 13 to 20 mm, and no rehospitalization or device-related adverse event occurred. We report a structured single-patient case using clinical examination, echocardiography, invasive hemodynamic assessment, laboratory markers, and 3-month follow-up after bicaval TricValve implantation.

Bicaval TricValve implantation resulted in marked symptomatic, biochemical, echocardiographic, and bedside clinical improvements. The resolution of Lancisi's sign may represent a simple marker of hemodynamic recovery after CAVI.