Combined Transcatheter Mitral and Tricuspid Valve Repair with Edge to Edge Technique

The Patient
• Elderly female (88), NYHA III dyspnea, active with daily activities
• Severe mitral regurgitation (ERO 43mm 2 , R VOL 60ml)
• Annular dilatation, degenerative leaflet changes, some hypermobility
• Severe tricuspid regurgitation (ERO 80mm 2
•Functional with annular dilatation
•LVEF 60%, non dilated
•Coronaries, 60% mid LAD, conservative Rx
•Pacemaker (6/2019), atrial fibrillation, arthritis, hypertension
•STS for mortality 5.76%
•HEART Team decision for transcatheter intervention, both mitral and tricuspid

TEE: Commissural Mitral View with Color

TEE: Simultaneous Biplane View of Mitral Valve
Commissural and Long Axis

Significant mitral regurgitation due to annular dilatation and hypermobility of both leaflets with some degenerative changes ERO 43mm 2 R VOL 60ml

Severe Functional Tricuspid Regurgitation

Evaluation of RV size and systolic function

  • Annular RV dimension
  • Tricuspid annulus S’ velocity
  • Longitudinal Strain of RV free wall

TEE: Transgastric 3D of the Tricuspid Valve

Tricuspid Valve Assessment: Mid-Esophageal Views

Advancement of PASCAL device in left atrium via transeptal puncture and change to closed configuration

Mitral Valve Repair with Pascal (10mm) in A2-P2 area

Note independent clasping of posterior leaflet for optimal result               Mild residual MR

Mitral Valve Repair with PASCAL P10 Comparison baseline and final result

Iatrogenic septal defect: Intermittent right to left shunting due to elevated right atrial pressures

Positioning of Pascal for Tricuspid Septal-Anterior Leaflet Clasping

Transgastric Short Axis Tricuspid View: Evaluation of correct orientation of Pascal device

Evaluation of leaflet insertion after closing the Pascal device

Tricuspid Valve Repair with Pascal (10mm)         Mild residual TR

Final color flow evaluation of interatrial septal defect: Left to right shunting only, after TV repair

Discharge Images

Color flow evaluation of the mitral valve in apical 4-chamber view

Color flow evaluation of the tricuspid valve in apical 4-chamber view