Dual transcatheter edge-to-edge repair in a patient with cardiac amyloidosis and severe secondary mitral and tricuspid regurgitation: a case report.

Abstract

Background: Mitral and tricuspid regurgitation in patients with cardiac amyloidosis (CA) pose significant diagnostic and therapeutic challenges due to its non-specific symptoms and limited treatment options. Transcatheter edge-to-edge repair (TEER) is complicated by altered cardiac geometry, advanced restriction, and potential amyloid valve deposits.

Case summary: We present the case of dual TEER in a 79-year-old male with advanced transthyretin cardiac amyloidosis (ATTR-CA) and severe symptomatic mitral and tricuspid regurgitation. In a staged approach, TEER for both the mitral and tricuspid valves was successfully conducted, resulting in improved valvular function and symptom relief. Transvalvular gradients were 5 mmHg for mitral valve and 2 mmHg for tricuspid valve, each with mild residual regurgitation, improved clinical status, and regressive natriuretic peptides.

Discussion: This case underscores the feasibility of dual TEER in CA patients with valvular involvement. Further research is necessary to optimize treatment strategies and address the multifaceted nature of this complex disease.