Clinical Improvement of Functional Mitral and Tricuspid Regurgitation Following Transcatheter Aortic Valve Implantation with the NAVITOR VISION System: A Case Report

Background

Concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) are frequently encountered in patients with severe aortic stenosis (AS) and are associated with adverse clinical outcomes after transcatheter aortic valve implantation (TAVI). However, the impact of transcatheter heart valve selection on postprocedural multivalvular hemodynamics remains incompletely understood.

Case Summary

An 87-year-old woman with symptomatic low-flow, low-gradient aortic stenosis (AS) complicated by moderate-to-severe mitral regurgitation (MR) and severe tricuspid regurgitation (TR) was admitted with refractory heart failure despite intensive medical therapy. Given her advanced age, frailty, and high surgical risk, transfemoral transcatheter aortic valve implantation (TAVI) was performed using a 23-mm Navitor™ Vision valve (Abbott Structural Heart, Santa Clara, CA, USA).

Valve selection was guided by the presence of a small aortic annulus and the need to balance optimal haemodynamic performance with minimisation of potential mitral valve interaction. The procedure was successfully completed without significant residual transvalvular gradient or paravalvular leakage. Following TAVI, relief of afterload was achieved, leading to improvement in functional MR and TR, with discontinuation of inotropic support. Follow-up echocardiography demonstrated reduction in both MR and TR, accompanied by a decrease in right ventricular systolic pressure.

Conclusion

We report a case of symptomatic low-flow, low-gradient AS with concomitant MR and TR that was successfully treated with TAVI using a Navitor Vision valve. In patients with small annuli and complex multivalvular disease, careful transcatheter heart valve selection and procedural optimisation may facilitate favourable haemodynamic outcomes and reverse remodelling.