Pacing Through the Complications: From TEER to TTR to Pacemaker in Tricuspid Valve Repair
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
Journal of the American College of Cardiology
Abstract
Background: Single leaf device attachment (SLDA) and complete heart block (CHB) are rare complications of tricuspid TEER. We present a case of tricuspid TEER complicated by SLDA followed by TTVR complicated by CHB, requiring PPM placement. Case: An 89-year-old female with a history of atrial fibrillation, severe mitral regurgitation (status post mitral TEER), and severe tricuspid regurgitation (status post tricuspid TEER) presented with worsening dyspnea and dizziness. ECHO revealed SLDA with detachment of the anterior leaflet of the tricuspid valve. TTVR with a 52 mm Evoque valve was successfully performed with a post-procedure ECHO showing trace paravalvular and transvalvular regurgitation with a mean gradient of 1 mmHg. However, the procedure was complicated by postoperative bradycardia in the cardiac ICU. Decision-making: Serial EKGs showed atrial fibrillation with a slow ventricular response and telemetry captured episodes of heart block with a junctional escape rhythm with heart rates in the 40s. The sinus node dysfunction was likely due to inflammation and mechanical compression around the AV node. Consequently, a single-chamber PPM was implanted by electrophysiology, and the patient was discharged with improvement in her symptoms. Conclusion: As TEER procedures become more widespread, so too may the recognition of their rare complications. This case may represent the first reported instance of both SLDA and CHB following TEER and subsequent TTVR in tricuspid valve disease. Early identification and prompt management of such complications are crucial to optimize patient outcomes.
Volume
85
Issue
12 Suppl
First Page
3309
Last Page
3309
Recommended Citation
Alakhras H, Chandra R, Jabri A, Birk V, Bloomingdale R, Renard B. Pacing through the complications: from TEER to TTVR to pacemaker in tricuspid valve repair. J Am Coll Cardiol. 2025 Apr 1;85(12 Suppl):3309. doi:10.1016/S0735-1097(25)03793-3
DOI
10.1016/S0735-1097(25)03793-3
Comments
American College of Cardiology Meeting, March 29-31, 2025, Chicago, IL