A case of catheter-based tricuspid valve repair reversing the prior success of transcatheter mitral valve repair.

Abstract Concomitant severe mitral/tricuspid regurgitation is observed in up to 30% of patients with reduced left ventricular ejection fraction. In symptomatic subjects at high surgical risk, transcatheter treatment is a viable option in the presence of suitable anatomy. We present a case of mitral regurgitation worsening after TriClip implantation in a patient with a previous successful MitraClip intervention. The correction of tricuspid regurgitation by catheter repair improves overall hemodynamics, but it can sometimes paradoxically worsen mitral regurgitation, as herein displayed. Clinical care is needed to detect tricuspid regurgitation-repair induced mitral regurgitation-worsening and ensure optimal management. We report a case of catheter-based tricuspid valve repair reversing the prior success of transcatheter mitral valve repair. The underline mechanism is likely related to the improved right ventricle forward output with a resulting greater preload on the left heart, with increased mitral regurgitation possibly related to increased tethering forces and/or tenting of the mitral valve apparatus.