Acute Left Heart Failure Following Transcatheter Tricuspid Valve Replacement

Transcatheter tricuspid valve replacement has demonstrated efficacy in reducing the severity of tricuspid regurgitation and improving functional capacity. However, postoperative complications require further investigation. We present 2 cases of patients who developed acute left heart failure following transcatheter tricuspid valve replacement. Both patients presented with clinical manifestations including dyspnea, pulmonary crackles, hypoxemia, bilateral pulmonary edema on chest radiography, and elevated N-terminal pro-B-type natriuretic peptide levels. Notably, diuretic therapy combined with inotropic agents and noninvasive ventilatory support was effective in improving symptoms. The underlying mechanism of this complication is related to an abrupt increase in right ventricular output that exceeds the left ventricle's capacity to accommodate. Potential risk factors include left ventricular diastolic dysfunction and small left ventricular dimensions. Importantly, acute left heart failure has also been observed following other right-sided heart procedures with similar mechanisms. To prevent and manage this complication, comprehensive perioperative management is crucial, including identifying high-risk factors preoperatively and actively treating heart failure postoperatively.