DragonFly™ edge-to-edge repair of the systemic atrioventricular valve in a patient with congenitally corrected transposition of the great arteries: a case report

Congenitally corrected transposition of the great arteries (ccTGA) features atrioventricular and ventriculo-arterial discordance. A substantial proportion of patients with ccTGA develop systemic right ventricular dysfunction and overload, leading to functional systemic atrioventricular valve (SAVV) regurgitation that markedly worsens clinical outcomes. Isolated SAVV interventions, specifically transcatheter edge-to-edge repair (TEER), have been scarcely reported.

An 84-year-old man with ccTGA was referred for treatment of severe systemic atrioventricular valve regurgitation. The patient had a history of atrial fibrillation and presented with progressive heart failure symptoms despite optimal guideline-directed medical therapy (GDMT). Owing to advanced age, multiple comorbidities, and a prohibitive surgical risk, the multidisciplinary Heart Team opted for transcatheter edge-to-edge repair using the DragonFly^TM system. Systemic atrioventricular valve repair was successfully performed with implantation of two clips under transoesophageal echocardiographic guidance. The postoperative course was uneventful, with significant reduction of regurgitation and improvement in function status during follow-up.

Our case demonstrates that transcatheter edge-to-edge repair using the DragonFly™ system may represent a feasible alternative for selected patients with ccTGA and functional systemic atrioventricular valve regurgitation who are at prohibitive surgical risk. Careful patient selection and meticulous procedural planning based on multimodality imaging are essential to achieve optimal outcomes in this complex population.