Case & Plan : 88-year-old female with hypertension, non-ischemic cardiomyopathy with LVEF 40%, ICD, symptomatic severe mitral regurgitation post mitral transcatheter edge-to-edge repair (TEER), moderate pulmonary Hypertension, atrial fibrillation and frailty who presents with progressive dyspnea NYHA class III and recurrent hospitalizations for decompensated heart failure. Transesophageal echocardiogram (TEE) showed severe tricuspid regurgitation [EROA (PISA) = 0.47 cm^2, regurgitant volume (PISA) = 57 mL]. The heart team found the patient at prohibitive risk for surgical tricuspid valve repair or replacement and recommended Transcatheter approach. Now planned for TTVR via percutaneous femoral venous access using a 48 mm Evoque valve under GA and TEE & 3D intracardiac echo (ICE) guidance.
