Case and Plan:
87-year-old female presents with progressive dyspnea, fatigue and dizziness NYHA class III over the last 12 months. Past medical history of hypertension, and multiple heart failure admissions (most recent 4 weeks ago) requiring iv diuretics and escalation of oral diuretics. Diagnosed with severe TR in 2025 and advised valve repair. Current TEE showed severe valvular TR (mixed etiology Myxomatous valve with annular dilation – atrial functional), large coaptation gap, dilated RA and RV with mildly reduced RV function. She also has mild MR, aortic sclerosis with LVEF of 45%. Patient was evaluated by the Heart Team and was deemed high risk for surgical valve repair in view of age and frailty. CT scan showed tricuspid annulus of 53.5*40.6(Avg 47mm), annular area 17.8cm2 and perimeter of 152.3mm. The patient was deemed suitable for TTVR with a 52mm Evoque valve via right femoral vein access.
