Transjugular LuX-Valve Plus transcatheter tricuspid valve replacement for torrential tricuspid regurgitation in a patient with a giant right atrium and multiple prior valve interventions: a case report

Transcatheter tricuspid valve replacement (TTVR) is an option for selected patients with severe tricuspid regurgitation (TR) who are at high surgical risk, but experience remains limited in those with extreme right-heart anatomy, including a giant right atrium and a markedly enlarged elliptical tricuspid annulus.

A 62-year-old man was admitted with progressive dyspnoea and lower-extremity oedema (NYHA class IV). He had previously undergone mechanical mitral valve replacement and transcatheter aortic valve replacement. Echocardiography and computed tomography angiography (CTA) showed torrential TR, a giant right atrium (11.59 × 7.73 cm), preserved right ventricular systolic function, and a markedly elliptical annulus with a perimeter-derived diameter of 55.5 mm. Persistent TR despite satisfactory left-sided prosthetic valve function prompted transcatheter evaluation. Redo surgery was prohibitive and transcatheter edge-to-edge repair was unsuitable. The Heart Team selected LuX-Valve Plus because its leaflet graspers and septal anchor provide radial force-independent multipoint fixation. A 79.2-mm bend-point-to-annulus distance exceeded the proposed 45–70 mm range, requiring a slightly lateral jugular entry angle and complicating depth control and coaxial alignment. The mechanical mitral prosthesis limited visualization by transoesophageal echocardiography (TEE) but served as a fluoroscopic landmark; TEE and fluoroscopy enabled successful implantation. At 1 month, NYHA class improved to II, with stable prosthetic haemodynamics, no obvious transvalvular regurgitation, and trivial paravalvular leak; findings remained stable at 6–7 weeks.

This case highlights the feasibility of transjugular LuX-Valve Plus TTVR in extreme right-heart anatomy and emphasizes the importance of anatomy-driven device selection, tailored delivery and imaging strategies, and individualized postprocedural management.