Topaz transjugular transcatheter tricuspid valve replacement

A 74-year-old female with severe tricuspid regurgitation (TR), New York Heart Association Class III dyspnoea, oedema, and fatigue was referred for transcatheter tricuspid valve intervention. Past medical history included atrial fibrillation, hypertension and diabetes. Echocardiography demonstrated torrential TR due to a large malcoaptation gap and multiple scallops, with preserved right ventricular function (Figure 1A, Moving image 1). Computed tomography (CT) imaging revealed a tricuspid annular area of 12.7 cm², with significant offset between the inferior vena cava (IVC) and tricuspid annulus, precluding coaxial valve delivery via the femoral approach (Figure 1B). After Heart Team review, she underwent transcatheter tricuspid valve replacement (TTVR) using a 45 mm Topaz device (TRiCares)1 via the transjugular approach. After percutaneous right internal jugular venous access, an Agilis steerable sheath (Abbott) was used to place an extra small SAFARI wire (Boston Scientific) in the apex of the right ventricle (RV), using right coronary wire markers and RV angiography to define the tricuspid annulus (Figure 1C). Under fast pacing, a Topaz 45 mm valve was implanted in a stable position with trace...