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Transjugular Tricuspid Edge-to-Edge Repair for Hostile Inferior Vena Cava Anatomy
Gioel Gabrio Secco1, Edoardo Elia2, Chiara Sartori2
1Division of Cardiology, University Hospital SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
Objective:
To describe a step-by-step transjugular approach for tricuspid transcatheter edge-to-edge repair (T-TEER) when hostile inferior vena cava anatomy precludes safe transfemoral access.
Key Steps:
We describe a case transjugular T-TEER in a patient with severe tricuspid regurgitation and prohibitive inferior vena cava anatomy. Distal right jugular access was obtained under ultrasound guidance with preclosure. Progressive dilation allowed advancement of the guiding catheter over stiff guidewire. Navigation toward tricuspid valve required awareness of reversed catheter movements to maintain orientation. Two devices were implanted in the anteroseptal position under echocardiographic guidance, using the first clip as landmark for the second one. The system was straightened before withdrawal.
Potential Pitfalls:
Large-bore jugular access may increase risk of vascular complications; distal puncture and gradual dilation are essential. Reversed catheter movements may cause disorientation or interaction with atrial structures.
Take-Home Message:
Transjugular access represents a feasible alternative for T-TEER when transfemoral delivery is unsafe.
