Leaflet Perforation as a Complication of Tricuspid Transcatheter Edge-to-Edge Repair.
PMID 42274174 | PMCID PMC13261864 | DOI 10.1016/j.jaccas.2026.108136 · JACC. Case reports · 2026
BACKGROUND: Transcatheter edge-to-edge repair (TEER) has emerged as an effective minimally invasive treatment for severe tricuspid regurgitation (TR). CASE SUMMARY: A 68-year-old man known to have ischemic cardiomyopathy, atrial fibrillation, and severe TR presented with right heart failure requiring ascitic drainage. After heart team discussion, he was admitted for elective TEER. The procedure was performed under general anesthesia using the TriClip XTW system. During deployment of a second clip, transesophageal echocardiography revealed an iatrogenic perforation of the posterior leaflet. The clip was withdrawn, however attempts to plug the perforation were unsuccessful, resulting in severe residual TR. DISCUSSION: This case illustrates a serious complication of tricuspid TEER: iatrogenic leaflet perforation. It highlights the role of intraprocedural imaging in real-time complication recognition and decision-making. TAKE-HOME MESSAGES: Iatrogenic leaflet perforation is a critical risk during tricuspid TEER. Echocardiographic guidance is paramount for steering and immediate identification of procedural complications.
Validated evidence
| Type | Entity | Source evidence | Confidence | Extractor |
|---|---|---|---|---|
| phenotype | cardiomyopathy | “CASE SUMMARY: A 68-year-old man known to have ischemic cardiomyopathy, atrial fibrillation, and severe TR presented with right heart failure requiring ascitic drainage.” | 0.98 | phenotype_alias_lexicon_v2 |