Acute Left Heart Failure Following Transcatheter Tricuspid Valve Replacement (JACC Case Reports March 2026)-Article: Acute Left Heart Failure Following Transcatheter Tricuspid Valve Replacement

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This case series reports two patients who developed acute left heart failure (ALHF) after transcatheter tricuspid valve replacement (TTVR), a complication not previously reported after this procedure. Both patients had severe tricuspid regurgitation and underwent successful implantation of the LuX-Valve Plus system with elimination of TR. Within hours to days after surgery, each developed dyspnea, hypoxemia, pulmonary crackles, bilateral pulmonary edema on chest X-ray, hypotension, and marked rises in NT-proBNP, consistent with ALHF.<br /><br />The proposed mechanism is an abrupt increase in right ventricular forward output after elimination of severe TR, which suddenly increases left ventricular preload. In these patients, the left ventricle could not accommodate the new volume load. Risk factors included left ventricular diastolic dysfunction in the first patient and a small left ventricular size with impaired diastolic reserve in the second.<br /><br />Management included diuretics, inotropic support, vasopressors when needed, and noninvasive ventilation with BiPAP. The second patient also initially received pulmonary vasodilators, but these were stopped because they may have worsened left-sided volume loading. Both patients improved, were discharged, and had favorable follow-up outcomes with stable valve function and improved symptoms.<br /><br />The authors conclude that ALHF is a serious but manageable complication of TTVR. Careful preoperative screening for high-risk features such as diastolic dysfunction and small LV dimensions, along with prompt postoperative heart failure treatment and cautious fluid/vasodilator management, are essential.

Meta Tag

Concept Acute Left Heart Failure

Concept Transcatheter Tricuspid Valve Replacement

Concept Left Ventricular Diastolic Dysfunction

Concept Tricuspid Regurgitation

Concept Left Ventricular Dimensions

Keywords

acute left heart failure

transcatheter tricuspid valve replacement

tricuspid regurgitation

pulmonary edema

left ventricular preload

diastolic dysfunction

LuX-Valve Plus

hypoxemia

NT-proBNP

heart failure management

Acute Left Heart Failure

Transcatheter Tricuspid Valve Replacement

Left Ventricular Diastolic Dysfunction

Tricuspid Regurgitation

Left Ventricular Dimensions