Transcatheter Tricuspid Valve Replacement for Torrential Tricuspid Regurgitation in Complex Adult Congenital Heart Disease

Abstract

Background Severe tricuspid regurgitation (TR) carries high morbidity and is often undertreated in patients with complex congenital heart disease and prohibitive surgical risk. Case Summary A 33-year-old woman with complex congenital heart disease and multiple prior surgeries presented with progressive right-sided heart failure and torrential TR. Imaging demonstrated septal leaflet splinting by a transvenous pacing lead. She was unsuitable for surgery or transcatheter edge-to-edge repair. Following Heart Team assessment, transcatheter tricuspid valve replacement with a 48 mm EVOQUE valve (Edwards Lifesciences) was performed. Despite procedural challenges including delivery system septal bias, implantation was successful with mild residual TR and early symptomatic improvement. Discussion Transcatheter tricuspid valve replacement is an emerging option for high-risk patients. This case demonstrates feasibility in complex congenital anatomy with pacing leads, a group under-represented in current evidence. Take-Home Messages Transcatheter tricuspid valve replacement expands treatment options in high-risk congenital tricuspid regurgitation. Careful imaging and Heart Team planning are essential for success.