Severe Tricuspid Regurgitation and Transcatheter Bicaval Valves System implantation.Importance of the load to indication

Abstract

The management of patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging for the Cardiac Heart Team. Studying the load on the right ventricle and the interaction between among the ventricle, valve, and pulmonary artery could be the key to detecting such patients. The systolic pulmonary artery pressure (sPAP)/ pulmonary artery acceleration time (PAAT) ratio could be used as an indicator of a marker of pulmonary vascular load, to identify patients who could benefit from transcatheter tricuspid valve repair (TTVR). Case Report Previous replacement of mitral valve with mechanical prosthesis and subsequent echocardiographic feedback of precapillary pulmonary hypertension associated with severe tricuspid regurgitation. sPAP/PAAT Ratio was 0,6 in specific therapy; well-functioning mechanical mitral prosthesis. Cardiac surgery was ruled out. Another device as “Triclip” were excluded for the dilatation of tricuspid annulus and the retraction of the flaps.The choice of the device was directed toward a bicaval device called ‘TricValve’ . The concept of Caval Valve Implantation by placing a valve in the inferior vena cava and one in the superior vena cava, is to redirect the regurgitant jet from the failed tricuspid valve. Protection of the hepatic and renal veins from the effects of this chronic volume overload may help mitigate the symptoms of right heart congestion, principally ascites and lower extremity edema. sPAP/PAAT ratio < 0,6 could be used as an indicator of pulmonary vascular load,to identify patients could benefit fron TTVR