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Review
. 2020 May 15:7:61.
doi: 10.3389/fcvm.2020.00061. eCollection 2020.

Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions

Mirjam Gauri Winkel  1 , Fabien Praz  1 , Peter Wenaweser  1   2
Affiliations
Review

Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions

Mirjam Gauri Winkel et al. Front Cardiovasc Med. .

Abstract

Valvular heart disease is responsible for a high rate of morbidity and mortality, especially in the elderly population. With the emergence of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has considerably expanded during the past years. Interventional treatment of the mitral and tricuspid valve requires an individualized and versatile approach owing to the different etiologies of valvular dysfunction and the complex anatomy of the atrioventricular valves. This article aims to review recent developments, summarize the evidence, indications and limitations of the available systems, and provide a glimpse into the future of transcatheter interventions for the treatment of mitral and tricuspid valve disease.

Keywords: annuloplasty; cardioband; edge-to-edge repair; mitraclip; mitral interventions; pascal; tricuspid interventions; valvular heart disease.

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Figures

Figure 1
Figure 1
Case of leaflet approximation with PASCAL device in secondary MR. (A) Baseline color-Doppler echocardiographic assessment of MR. (B) Leaflet clasping. (C) Schematic depiction of the PASCAL system (courtesy of Edwards Lifesciences). (D) Assessment of the final result with color Doppler echocardiography.
Figure 2
Figure 2
Decision algorithm for transcatheter tricuspid valve interventions. TR, tricuspid regurgitation; OMT, optimal medical therapy; PHT, pulmonary hypertension; RV, right ventricle.
Figure 3
Figure 3
Case of combined mitral and tricuspid edge-to-edge repair in a 79-year old sympatomatic (NYHA III) male patient with prohibitive surgical risk (Euroscore II 21%). Baseline transesophageal assessment showed severe MR (A). After transseptal puncture, the mitral valve was treated first with the placement of one MitraClip XTR. with MR reduction to grade 1+ (B). Severe TR at baseline (C) Two MitraClip XTR were placed in the anteroseptal commissure with reduction of TR to mild (D). Final fluoroscopic result ((E), *MitraClip mitral, + MitraClips tricuspid).
See this image and copyright information in PMC

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