Successful transcatheter edge-to-edge repair for tricuspid regurgitation in a patient with a double-inlet left ventricle and discordant connections of the great arteries: a case report

Background: In patients with adult congenital heart disease (ACHD), significant atrioventricular valve regurgitation is an important risk factor for poor outcomes, such as heart failure. However, in many cases, transcatheter intervention may reduce the risk profile to avoid a high surgical risk.

Case summary: A 44-year-old man with complex ACHD in the form of a double-inlet left ventricle, congenitally corrected transposition of the great arteries, pulmonary atresia, atrial septal defect, and patent ductus arteriosus was referred for the treatment of severe tricuspid regurgitation. He received an aortopulmonary shunt and a left-sided modified Blalock-Taussig shunt during childhood. Because of the patient's high surgical risk due to seroma formation around the two shunts and intra-mediastinal collateral vessels, the heart team opted for transcatheter edge-to-edge repair (TEER) using a MitraClip (Abbott Vascular, Santa Clara, CA, USA). Tricuspid TEER was successfully performed using the MitraClip G4 system. The postoperative course was uneventful, with significant improvements in the New York Heart Association functional class.

Discussion: Our case demonstrates that tricuspid TEER can be an alternative option for patients with complex ACHD who are at high risk for conventional surgeries; however, careful assessment with multimodality imaging and a heart team approach, including a cardiologist, ACHD specialist, cardiac surgeon, anthologist, and intensivist, should be considered.