Transcatheter Tricuspid Valve Replacement in a Patient With Small Right Atrium and Multiple Device Leads

Severe tricuspid regurgitation (TR) in patients with small right atrial (RA) or right ventricular dimensions poses a significant challenge for transcatheter tricuspid valve replacement (TTVR).

A 39-year-old woman with prior coronary artery bypass grafting, mitral valve replacement, and LMNA cardiomyopathy with a dual-chamber implantable cardioverter-defibrillator presented with torrential TR. She was deemed to be a poor surgical candidate, and TTVR with the EVOQUE system was aborted due to insufficient RA height. She underwent TTVR with the Laplace system. Imaging confirmed resolution of TR, and the patient had notable and sustained improvements in her functional capacity and quality of life at 6-month follow-up.

This case demonstrates the feasibility of the Laplace TTVR system for treating severe TR in a patient with small RA/right ventricular size that precluded the use of currently available commercial TTVR devices.

Novel TTVR systems may provide additional options for treating TR in patients with challenging anatomy.