Vol. 53 | No. 1 | January-June 2025Back

Open Access

The First TricValve® Transcatheter Implantation in the Philippines: A Case Report on Novel Management of Severe Tricuspid Regurgitation

Jessielyn Sia, Aristides Panlilio, Bun Yok Dy, Timothy Dy
May 2025 DOI 10.69944/pjc.adc8da12a3

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Jessielyn Sia, MD | Aristides Panlilio, MD | Bun Yok Dy, MD | Timothy Dy, MD
Chinese General Hospital and Medical Center, Sta. Cruz, Manila, Philippines


Corresponding author:
Dr. Jessielyn Sia, M.D.
E-mail: jessielyn.e.sia@gmail.com

DISCLOSURE: None

References
  1. Kang DH, Kim MJ, Kang SJ. Tricuspid regurgitation: Clinical impact and treatment options in an Asian population. Korean Circ J. 2020;50(5):389–400.
  2. Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J. Transcatheter tricuspid valve interventions: Landscape, challenges, and future directions. J Am Coll Cardiol [Internet]. 2018;71(25):2935–56. Available from: http://dx.doi.org/10.1016/j.jacc.2018.04.031
  3. Dreyfus GD, Martin RP, Chan KMJ, Dulguerov F, Alexandrescu C. Functional tricuspid regurgitation: a need to revise our understanding. J Am Coll Cardiol [Internet]. 2015;65(21):2331–6. Available from: http://dx.doi.org/10.1016/j.jacc.2015.04.011
  4. Lauten A, Figulla HR, Unbehaun A, Fam N, Schofer J, Doenst T, et al. Interventional treatment of severe tricuspid regurgitation: Early clinical experience in a multicenter, observational, first-in-man study: Early clinical experience in a multicenter, observational, first-in-man study. Circ Cardiovasc Interv [Internet]. 2018;11(2):e006061. Available from: http://dx.doi.org/10.1161/CIRCINTERVENTIONS.117.006061
  5. Wild MG, Praz F. Caval valve implantation for advanced tricuspid regurgitation: Closing a therapeutic gap? JACC Cardiovasc Interv [Internet]. 2022;15(13):1378–81. Available from: http://dx.doi.org/10.1016/j.jcin.2022.05.043
  6. Blusztein DI, Hahn RT. New therapeutic approach for tricuspid regurgitation: Transcatheter tricuspid valve replacement or repair. Frontiers in Cardiovascular Medicine [Internet]. 2023; Available from: http://dx.doi.org/10.3389/fcvm.2023.1080101
  7. Brener MI, Lurz P, Hausleiter J, Rodés-Cabau J, Fam N, Kodali SK, et al. Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol [Internet]. 2022;79(5):448–61. Available from: http://dx.doi.org/10.1016/j.jacc.2021.11.031
  8. Luk KS, Wong CK. Right heart failure after TricValve implantation for symptomatic torrential tricuspid regurgitation: a case report. Journal of the Hong Kong College of Cardiology [Internet]. 2024;31(5). Available from: http://dx.doi.org/10.55503/2790-6744.1541
  9. Wong N, Jappar IA, Ho JS, Ewe SH, Tan SY, Tan JWC, et al. Torrential tricuspid regurgitation treated with TricValve. J Asian Pac Soc Cardiol [Internet]. 2022;1. Available from: http://dx.doi.org/10.15420/japsc.2022.11
  10. Marschall A, Rivero F, Bastante T, Cuesta J, Del Val D, Sarnago F, et al. Diaphragmatic paralysis after heterotopic bicaval stenting. JACC Case Rep [Internet]. 2024;29(15):102422. Available from: http://dx.doi.org/10.1016/j.jaccas.2024.102422
Tables and Figures

 

figure 1

Figure 1. (A). Transthoracic echocardiogram showing severe TR (yellow arrow) in apical 4 chamber view, RV inflow view demonstrating reflux to the inferior vena cava (green arrow), subcostal bi-caval view demonstrating reflux to the superior vena cava (red arrow);
(B). CT venogram measurements for the SVC showing SVC confluence diameter (19 mm), SVC at the level of above the PA diameter (21 mm), SVC at the level of the middle of PA diameter (26 mm), SVC at the level of the bottom of the PA diameter (33 mm), and length of confluence to SVC-RA junction (68 mm);
(C). CT venogram measurements for the IVC showing IVC-RA junction diameter (26 mm), IVC above the hepatic vein (HV) diameter (27 mm), IVC just below the HV diameter (27 mm), HV distance is 4.95 mm below the IVC-RA junction, HV ostium diameter (14 mm);
(D). TEE post CAVI demonstrating the IVC prosthesis (yellow arrow) and SVC prosthesis (green arrow) anchored to the right atrium and with no paravalvular leaks.

 

figure 2

Figure 2. (A). Hemodynamic study pre-CAVI showed elevated SVC and IVC V wave pressures, mean PA pressure of 25 mmHg, RA pressure of 25 mmHg; (B). IVC V wave post CAVI

 

figure 3

Figure 3. Deployment of TricValve®  

(A) The crown of the SVC valve 25mm was positioned above the SVC confluence, with the belly of the SVC bioprosthesis positioned above the right pulmonary artery.
(B) The IVC valve was positioned with a catheter in the HV, ensuring that the proximal edge of the valve was between 5-15 mm into the right atrium and ensuring that flow to the hepatic vein was not covered
(C) SVC and IVC prosthesis in place

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