Clinical Images

Combined Percutaneous Treatment of Severe Triscuspid Regurgitation and Left Atrial Appendage Closure

J INVASIVE CARDIOL 2019;31(1):E4-E5.

Key words: MitraClip, tricuspid repair, left atrial appendage closure

A 65-year-old woman was admitted to our institution for recurrent episodes of right heart failure. She reported previous history of ischemic heart disease, chronic kidney disease, and paroxysmal atrial fibrillation (CHA2DS2-VASc score, 4) with bleeding events on vitamin K antagonist and novel oral anticoagulants (HAS-BLED score, 5).

Transthoracic and transesophageal echocardiogram (TEE) revealed a severe tricuspid regurgitation (TR) due to annular dilation. The right ventricle was moderately dilated with normal right systolic function (Figure 2A). 

Due to high surgical risk, the patient was scheduled for percutaneous treatment of TR and simultaneous left atrial appendage (LAA) closure. 

The procedure was performed under general anesthesia and TEE monitoring. First, transseptal access was performed without complications. After assessing the left atrial appendage (LAA) size and morphology, a 21 mm Watchman device (Boston Scientific) was deployed with successful LAA occlusion (Figures 1A-1D). Subsequently, the Watchman sheath was pulled to the right atrium and exchanged for a MitraClip XTR guiding catheter (Abbott Vascular). After careful imaging of the tricuspid valve and the origin of the regurgitant jet, an XTR clip was deployed between the anterior and septal leaflets close to the center of the valve with reduction of the TR from severe to mild (Figures 2A-2D). 

LAA closure and MitraClip implantation in the tricuspid position in the same procedure is a feasible and safe option in patients with a high surgical risk suffering from severe symptomatic TR and bleeding complications under anticoagulant therapy.

From the Interventional Cardiology Unit, University Hospital Puerta de Hierro, Madrid, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rodrigo Estevez-Loureiro is a proctor for MitraClip and reports grant support from Abbott Vascular. The remaining authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted August 7, 2018. 

Address for correspondence: Rodrigo Estévez-Loureiro, MD, PhD, FESC, Interventional Cardiology Unit, University Hospital Puerta de Hierro, c/ Manuel de Falla 1, 28220 Majadahonda, Madrid, Spain. Email: