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Acute Tricuspid Leaflet Thrombus During Transcatheter Tricuspid Valve Repair

Year: 2025

Type: article

Abstract: BACKGROUND: Transcatheter tricuspid valve repair (TTVR) is a growing alternative for high-risk patients with tricuspid regurgitation; however, intraprocedural thrombotic events are rarely reported. CASE SUMMARY: An 80-year-old woman with chronic atrial fibrillation and severe functional tricuspid regurgitation underwent edge-to-edge TTVR with a 2-Pa device. Despite adequate anticoagulation (activated clotting time: >250 seconds), an acute mobile thrombus developed during catheter positioning. The clot, initially adherent to the delivery system, migrated to the posterior tricuspid leaflet. DISCUSSION: Because additional heparin failed to resolve it, thrombus aspiration under transesophageal echocardiography and intracardiac echocardiography guidance was successfully performed. TTVR was completed uneventfully with 2-Pa devices, and the patient was discharged in stable condition. At 1-month follow-up, she was NYHA functional class I. TAKE-HOME MESSAGE: This case highlights the risk of acute thrombus formation during TTVR, the importance of real-time imaging, and the efficacy of mechanical aspiration when anticoagulation fails.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105944

Authors: Dalila Nappa, Maria Luisa Salido-Tahoces, Ana García-Martín, Ángel Sánchez-Recalde, Covadonga Fernández-Golfín

Institutions: Federico II University Hospital, University of Naples Federico II, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, Hospital Universitario Ramón y Cajal

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850