Acute Tricuspid Leaflet Thrombus During Transcatheter Tricuspid Valve Repair

Transcatheter tricuspid valve repair (TTVR) is a growing alternative for high-risk patients with tricuspid regurgitation; however, intraprocedural thrombotic events are rarely reported.

An 80-year-old woman with chronic atrial fibrillation and severe functional tricuspid regurgitation underwent edge-to-edge TTVR with a 2-Pa device. Despite adequate anticoagulation (activated clotting time: >250 seconds), an acute mobile thrombus developed during catheter positioning. The clot, initially adherent to the delivery system, migrated to the posterior tricuspid leaflet.

Because additional heparin failed to resolve it, thrombus aspiration under transesophageal echocardiography and intracardiac echocardiography guidance was successfully performed. TTVR was completed uneventfully with 2-Pa devices, and the patient was discharged in stable condition. At 1-month follow-up, she was NYHA functional class I.

This case highlights the risk of acute thrombus formation during TTVR, the importance of real-time imaging, and the efficacy of mechanical aspiration when anticoagulation fails.