Acute mitral regurgitation after transcatheter tricuspid valve replacement – case report

Transcatheter tricuspid valve replacement (TTVR) has emerged as a therapeutic option for patients with severe tricuspid regurgitation (TR) who are ineligible for surgery.

We report the first case of acute development and transient resolution of severe mitral regurgitation (MR) following TTVR device implantation. Baseline transthoracic echocardiography (TTE) showed torrential TR and mild to moderate MR. Immediately after TTVR-device implantation, transoesophageal echocardiography (TOE) revealed severe MR. Over the following days, MR gradually improved, and TTE at discharge showed only mild to moderate MR.

This case illustrates that abrupt elimination of TR can lead to acute worsening of MR, likely precipitated by an abrupt increase in left ventricular preload in the presence of diastolic dysfunction. In conclusion, caution is warranted in patients with pre-existing left ventricular dysfunction undergoing TTVR, as the procedure may exacerbate functional MR. Periprocedural volume unloading may help ameliorate the impact of acute haemodynamic changes.