Transcatheter edge-to-edge repair of both atrio-ventricular valves in congenitally corrected transposition of the great arteries: a case report

Transcatheter edge-to-edge repair (TEER) for the systemic atrioventricular valve has been anecdotally reported as a viable treatment option in symptomatic inoperable adult patients born with congenitally corrected transposition of the great arteries (ccTGA) . However, to date, case reports on TEER treatment of both atrioventricular valves are lacking, especially when considering the present availability of specific mitral and tricuspid valve TEER devices. We present the case of an 84-year-old man with recurrent admissions for acute heart failure due to high-grade regurgitation of both atrioventricular valves. The patient was first diagnosed with ccTGA at this advanced age and underwent a thorough multimodality imaging approach, including transthoracic and transesophageal echocardiography, cardiac MRI, cardiac CT, and ventriculography of the systemic ventricle. Due to the high symptom burden despite optimal medical therapy and high doses of diuretics, the Heart Team recommended TEER, first for the systemic tricuspid valve, and later on for the non-sytemic mitral valve. Both complex procedures were uneventful and led to considerable improvement in quality of life. ccTGA mostly manifests itself in adulthood and affects both ventricles and atrioventricular valves. In case of anatomical doubts on transthoracic echocardiography, a thorough multimodality imaging work-up is recommended. Transcatheter treatment of both atrioventricular valves seems to be a safe and effective therapeutic option in these often-inoperable patients.