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Updated: Mar 15, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Isolated Transcatheter Tricuspid Valve Edge-to-Edge Repair in Repaired Tetralogy of Fallot
Omar Azizi1, Zakaria Jalal1, Julien Ternacle2
1Department of Pediatric and Congenital Cardiology, National Reference Center for Complex Congenital Heart Disease, Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
Background:
Adults with repaired tetralogy of Fallot (rTOF) frequently develop right heart failure, most commonly related to pulmonary regurgitation. Tricuspid regurgitation (TR) is an underrecognized contributor. Transcatheter edge-to-edge repair (TEER) has emerged as an alternative to surgery, but evidence in congenital heart disease remains limited.
Case Summary:
We report the first case of isolated tricuspid valve repair using TriClip in an adult with rTOF and severe symptomatic TR. Preprocedural transesophageal echocardiography demonstrated type IIIb anatomy with a 6-mm coaptation gap. The initial clip entrapment resulted in chordal rupture and transient TR worsening. Two additional clips were successfully implanted, leading to significant TR reduction and clinical improvement.
Discussion:
This case highlights both the feasibility and technical challenges of TEER in complex congenital anatomy.
Take-Home Messages:
TR contributes to right heart failure in rTOF. The tricuspid subvalvular apparatus may be fragile; nevertheless, TEER remains feasible and clinically beneficial in selected patients.
