Asia’s First Tricuspid Valve Clipping Treatment
Jan 08, 2024
In a first of its kind case, Medanta treated a 57-year-old patient from Nepal for severe tricuspid regurgitation using the MitraClip – effectively adopting a new minimally invasive approach to treating the condition. Performed by Dr Praveen Chandra (Chairman, Interventional and Structural Heart Cardiology, Heart Institute), this was the first time a tricuspid valve clipping procedure had been performed in Asia. 8 days after the procedure, the patient underwent a liver transplant performed by Dr Arvinder Singh Soin (Chairman, Institute of Liver Transplantation and Regenerative Medicine).
Dr Arvinder Singh Soin said, “The patient had chronic liver disease which he developed in 2008 after suffering from Hepatitis C. On two occasions - once in 2011 and then again in 2018 - he developed gastrointestinal bleeding and decompensation with ascites. Both these episodes were managed well at Medanta with medication. In May 2023 he presented to the hospital again, this time with severe decompensated liver disease. He needed a liver transplant; however, he was also suffering from severe tricuspid regurgitation which made him unfit for transplantation.”
Dr Praveen Chandra said, “Tricuspid regurgitation is a condition that occurs when the tricuspid valve in the heart fails to close properly, leading to blood flowing back into the right atrium. This can cause a variety of symptoms, including fatigue, shortness of breath, heart palpitations and ascites. Severe tricuspid regurgitation can also progress to liver cirrhosis. The presence of severe tricuspid regurgitation means that a liver transplant surgery cannot take place.”
He adds, “While isolated tricuspid valve surgery is done occasionally, it is associated with high mortality. Alternate options for percutaneous interventions are still at a nascent stage. Therefore, we decided to use the Mitraclip, which has shown promising results in treating tricuspid regurgitation. During the procedure, a small clip is placed on the leaflets of the tricuspid valve to help it close properly. It is performed using advanced 3D echocardiographic imaging, under general anaesthesia. Unlike traditional surgeries, tricuspid clipping treatment does not require the chest to be opened up, and recovery time is much shorter. Studies have shown it to be safe and effective with patients reporting significant improvement in their symptoms.”
Dr Soin adds, “After 8 days the patient stabilised, and we performed the liver transplant. The transplant was a challenging one because the healing time was comparatively less. Two major surgeries were being performed within a short span of time. In the past many years, such cases have not had positive outcomes. However, this was the first such patient we were able to save. This unique approach represents a paradigm shift in how we approach complex medical cases like these. the successful heart valve repair paved the way for the subsequent liver transplant, marking a medical milestone in simultaneous treatment of multiple This breakthrough has far-reaching implications for the medical community and patients worldwide."