JACC. Case reports · 2026
A Novel Commissural Symmetrical Closure Strategy for Transcatheter Tricuspid Annuloplasty Enabling Maximized Annular Reduction.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Cao Yuan, Ma Minghao, Lu Chenna, Pei Jialiang, Gao Tingwen, Pan Wenzhi
Аннотация
BACKGROUND: Refractory functional tricuspid regurgitation (TR) secondary to annular dilatation portends poor prognosis, although conventional open tricuspid surgery carries high-risk in elderly patients. The optimal K-Clip deployment geometry for maximal annular reduction remains undefined.
CASE SUMMARY: An 89-year-old pacemaker-dependent man with decompensated right heart failure and refractory functional TR was prohibitively high-risk for open surgery. Preoperative imaging identified anatomy less favorable for transcatheter edge-to-edge tricuspid repair. K-Clips were implanted perpendicularly to tricuspid commissures via the commissural symmetrical closure (CSC) strategy, yielding significant annular reduction. Three-month follow-up showed sustained TR improvement and stable clip positioning.
DISCUSSION: Perpendicular orientation geometrically maximizes annular plication, enabling optimal annular contraction and TR relief. Dual fluoroscopic and live 3D transesophageal echocardiographic guidance ensures safe and precise deployment.
TAKE-HOME MESSAGE: The commissural symmetrical closure strategy optimizes K-Clip geometric alignment to maximize tricuspid annular reduction and ameliorate severe functional TR, offering a safe and feasible transcatheter annuloplasty approach for high-risk elderly patients.
CASE SUMMARY: An 89-year-old pacemaker-dependent man with decompensated right heart failure and refractory functional TR was prohibitively high-risk for open surgery. Preoperative imaging identified anatomy less favorable for transcatheter edge-to-edge tricuspid repair. K-Clips were implanted perpendicularly to tricuspid commissures via the commissural symmetrical closure (CSC) strategy, yielding significant annular reduction. Three-month follow-up showed sustained TR improvement and stable clip positioning.
DISCUSSION: Perpendicular orientation geometrically maximizes annular plication, enabling optimal annular contraction and TR relief. Dual fluoroscopic and live 3D transesophageal echocardiographic guidance ensures safe and precise deployment.
TAKE-HOME MESSAGE: The commissural symmetrical closure strategy optimizes K-Clip geometric alignment to maximize tricuspid annular reduction and ameliorate severe functional TR, offering a safe and feasible transcatheter annuloplasty approach for high-risk elderly patients.