case_images: PMC11104546_01
case_images: Cardiac computed tomography measurements (tricuspid valve annular segmentation and dimensions). TA: Tibialis anterior
case_images: HV-25-46-g001.jpg
case_images: PMC11104546_01_HV-25-46-g001.jpg
case_images: heartviews.heartviews_89_23-F1
case_images: Cardiac computed tomography (CT) showed tricuspid annulus perimeter: 206.8 mm; area: 3279.7 mm2; maximum diameter: 71.9 mm; anterior annulus length (A): 73.0 mm; posterior annulus length (P): 74.4 mm; septal annulus length (S): 57.2 mm [Figure 1].
case_images: The K-clip  procedure: (a) Transvascular access; (b) Sheath position; (c) Anchor deployment; (d) Clamping annulus tissue; (e) Sandwich formed; (f): Release
case_images: HV-25-46-g002.jpg
case_images: PMC11104546_01_HV-25-46-g002.jpg
case_images: heartviews.heartviews_89_23-F2
case_images: After the right jugular vein puncture, lead K-clip  sheath introducer access RA throughout superior vena cava, in addition, a guide catheter needs to be placed in the right coronary artery via femoral access because of the close proximity of the right coronary artery to the posterior portion of the tricuspid annulus; Step 2; Sheath position: Figure out the tricuspid annulus guided by TEE and position the sheath introducer; Step 3; Anchor deployment: Under the guidance of echo, the anchor of K-clip  reaches the midpoint of the posterior tricuspid annulus and tap the anchor screw into annulus; Step 4; Clamping annulus tissue: Under the guidance of echoc, clamp the tissue to fold the tricuspid annulus and then close the clip arms slowly; Step 5; Sandwich formed: Form the stable "anchor-tissue-clamp arm" sandwich structure; Step 6; Release: Release the sandwich-like K-clip  and withdraw the delivery system [Figure 2]. After 16T K-clip  was released, resulting in annular and TR reduction, but there was still TR moderate to severe TR, thus, the second K-clip  (12T) was performed [Figure 3].
case_images: 16T and 12T K-clip  were selected for implantation
case_images: HV-25-46-g003.jpg
case_images: PMC11104546_01_HV-25-46-g003.jpg
case_images: heartviews.heartviews_89_23-F3
case_images: After the right jugular vein puncture, lead K-clip  sheath introducer access RA throughout superior vena cava, in addition, a guide catheter needs to be placed in the right coronary artery via femoral access because of the close proximity of the right coronary artery to the posterior portion of the tricuspid annulus; Step 2; Sheath position: Figure out the tricuspid annulus guided by TEE and position the sheath introducer; Step 3; Anchor deployment: Under the guidance of echo, the anchor of K-clip  reaches the midpoint of the posterior tricuspid annulus and tap the anchor screw into annulus; Step 4; Clamping annulus tissue: Under the guidance of echoc, clamp the tissue to fold the tricuspid annulus and then close the clip arms slowly; Step 5; Sandwich formed: Form the stable "anchor-tissue-clamp arm" sandwich structure; Step 6; Release: Release the sandwich-like K-clip  and withdraw the delivery system [Figure 2]. After 16T K-clip  was released, resulting in annular and TR reduction, but there was still TR moderate to severe TR, thus, the second K-clip  (12T) was performed [Figure 3].
case_images: Echocardiography was used to assess the changes of tricuspid regurgitation (TR) after K-clip . (a) Dilated tricuspid annulus with torrential TR at baseline, (b) After K-clip , reducing TR
case_images: HV-25-46-g004.jpg
case_images: PMC11104546_01_HV-25-46-g004.jpg
case_images: heartviews.heartviews_89_23-F4
case_images: TR, and the absence of pericardial effusion [Figure 4]. The patient was then discharged with Edoxaban (30 mg/d) as an antithrombotic treatment.