PMC10445134_01
(A) Intraprocedural TEE showing torrential TR with EROA of 0.74 cm2, regurgitation volume of 51 ml, and vena contracta width of 0.71 cm (upper panel) and 3D work plane revealing the original knot of the Kay's procedure (red arrow) and TA morphology before K-Clip  implantation (lower panel). (B) Real-time fluoroscopy (upper panel) and 3D work plane of TEE (lower panel) showing the opening clamp and the clip on the target location after release. (C) Postprocedural TEE showing an immediate reduction of TR grade with an EROA of 0.16 cm2, regurgitation volume of 12 ml, and vena contracta width of 0.27 cm (upper panel) and 3D work plane (lower panel) showing the TA morphology after K-Clip  implantation (red arrow). TEE, transesophageal echocardiogram; TR, tricuspid regurgitation; EROA, effective regurgitant orifice area; TA, tricuspid annulus.
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F2
TEE confirmed the torrential TR (vena contracta width of 0.71 cm), as well as that the distance between the target sites for clip implantation and the knot of the prior Kay's procedure (Figure 2A) was approximately 18-20 mm, which was enough space for a 16 mm clip to clamp the posterior annular tissue. The K-Clip  system was percutaneously inserted via the right jugular vein and steered toward the posterior TA. Then, the tapping screw-shaped anchor was inserted through the target location, and the clip was tangentially opened and oriented to the annulus, slowly pulled back with the surrounding TA tissue, and then clamped the clip, achieving tissue plication and re-bicuspidization (Figure 2B). TR grade (torrential to mild, vena contracta width of 0.25 cm) and TA dimensions was immediately observed (Figure 2C). Throughout the whole procedure, it was carefully confirmed that the original knot was not loose and meanwhile the right coronary artery flow was not interfered by the manipulation.
Transthoracic echocardiography after 3 months of follow-up. (A) Showing mild residual tricuspid regurgitation. (B) Showing the secure position of the device (yellow arrow).
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F3
After 3 months of follow-up, repeated transthoracic echocardiography demonstrated mild TR (Figure 3A) and the secure position of the device (Figure 3B).