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Updated: Oct 1, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
A Novel Commissural Symmetrical Closure Strategy for Transcatheter Tricuspid Annuloplasty Enabling Maximized Annular
Yuan Cao1, Minghao Ma2, Chenna Lu3
1National Key Laboratory for Innovation and Transformation of Luobing Theory, Shijiazhuang City, Hebei Province, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, Shandong Province, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Background:
Refractory functional tricuspid regurgitation (TR) secondary to annular dilatation portends poor prognosis, although conventional open tricuspid surgery carries high-risk in elderly patients. The optimal K-Clip deployment geometry for maximal annular reduction remains undefined.
Case Summary:
An 89-year-old pacemaker-dependent man with decompensated right heart failure and refractory functional TR was prohibitively high-risk for open surgery. Preoperative imaging identified anatomy less favorable for transcatheter edge-to-edge tricuspid repair. K-Clips were implanted perpendicularly to tricuspid commissures via the commissural symmetrical closure (CSC) strategy, yielding significant annular reduction. Three-month follow-up showed sustained TR improvement and stable clip positioning.
Discussion:
Perpendicular orientation geometrically maximizes annular plication, enabling optimal annular contraction and TR relief. Dual fluoroscopic and live 3D transesophageal echocardiographic guidance ensures safe and precise deployment.
Take-Home Message:
The commissural symmetrical closure strategy optimizes K-Clip geometric alignment to maximize tricuspid annular reduction and ameliorate severe functional TR, offering a safe and feasible transcatheter annuloplasty approach for high-risk elderly patients.
