Transjugular Tricuspid Valve Edge-to-Edge Repair.

BACKGROUND

Transcatheter tricuspid valve edge-to-edge repair (TV TEER) is an established option for selected high-risk patients with severe tricuspid regurgitation (TR), but procedural success depends on favorable device trajectory and coaxiality.

CASE SUMMARY: A 79-year-old man with wild-type transthyretin amyloidosis, atrial fibrillation status post left atrial appendage closure, pulmonary hypertension, chronic kidney disease, and recurrent heart failure admissions presented with NYHA functional class III symptoms and torrential functional TR. Imaging showed severe right-sided dilation and a prominent Eustachian ridge. Transfemoral TV TEER was attempted but failed because the ridge displaced the delivery system anteriorly and septally, preventing adequate alignment. The procedure was converted to a right internal jugular approach, allowing successful implantation of 2 clips and reduction of TR from torrential to mild without significant gradient.

DISCUSSION: A prominent Eustachian ridge may complicate transfemoral TV TEER. In selected anatomically challenging cases, a transjugular approach can provide a useful alternative for successful repair.