Transcatheter tricuspid valve replacement (TTVR) has demonstrated efficacy in reducing the severity of tricuspid regurgitation and improving functional capacity. However, postoperative complications require further investigation. We present two cases of patients who developed acute left heart failure (ALHF) following TTVR. Both patients presented with clinical manifestations including dyspnea, pulmonary crackles, hypoxemia, bilateral pulmonary edema on chest radiography, and elevated NT-proBNP levels. Notably, diuretic therapy combined with inotropic agents and non-invasive 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, ALHF 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.
JACC Case Reports Interim Editors-in-Chief
Gilbert H. L. Tang, MD, MSc, MBA
CME Editor
Kenneth A. Ellenbogen, MD
Author
Matthew Ian Tomey, MD, FACC
Important Dates
Date of Release: March 4, 2026
Term of Approval/Date of CME/MOC Expiration: March 3, 2027