Transcatheter bi-caval valve implantation in a post-pacemaker patient with severe tricuspid regurgitation: A case report.

Severe tricuspid regurgitation (TR) presents a significant clinical challenge in patients deemed unsuitable for conventional surgical intervention. This case describes a 60-year-old woman with torrential TR and intractable ascites with a dual-chamber pacemaker in situ who presented with refractory right heart failure unresponsive to maximal medical therapy. Transcatheter bicaval valve implantation was performed with computed tomography guidance, deploying 29-mm and 35-mm self-expanding nitinol-pericardial valves in the superior and inferior vena cavae. At six-month follow-up, the patient demonstrated marked clinical improvement with substantial reduction in ascites and resolution of venous congestion, establishing bicaval valve implantation as an effective palliative strategy for alleviating systemic venous hypertension in high-risk patients with end-stage TR and prohibitive surgical risk, despite limited right ventricular structural recovery. Learning objective: 1)To recognize the clinical presentation, hemodynamic findings, and diagnostic features of severe, symptomatic tricuspid regurgitation.2)To understand the anatomic and hemodynamic principles underlying transcatheter heterotopic bicaval valve implantation (CAVI) as a palliative strategy in patients with advanced right heart remodeling and prohibitive surgical risk.3)To understand the short- and medium-term symptomatic and hemodynamic outcomes of CAVI.