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Severe tricuspid regurgitation is independently associated with an increased mortality. Recent studies show that surgery for isolated tricuspid valve (TV) is still associated with the highest surgical risk of all valve procedures. Percutaneous treatments for the management of tricuspid regurgitation have become an alternative to surgery in select patients of high surgical risk. To this day, the most widely used device is MitraClip in the tricuspid position. We reviewed the different devices used today for transcatheter treatments paying special attention to MitraClip. We describe the basic standpoints on transesophageal echocardiography screening and step-by-step procedure for the implantation of the clip. This document stands as a guide to systematize tricuspid valve assessments and the steps involved in device implantation to achieve successful procedures.

Percutaneous transluminal septal ablation is an alternative treatment in patients with hypertrophic obstructive cardiomyopathy. However, due to the relatively new introduction of this technique, there is no information on its very long term results (10 years).The present study included consecutive patients treated in 5 centers between 1998 and 2003. We analyzed clinical, hemodynamic, and echocardiographic data at baseline and follow-up.A total of 45 patients were included; there were 31 (69%) women, the mean age was 62.4 (14) years, and 39 patients (86.6%) showed functional class III or IV. Septal thickness was 21.8 (3.5) mm, the peak resting gradient on echocardiography was 77 (39) mmHg, and mitral regurgitation was at least moderate in 22 patients (48.8%). During hospitalization, permanent pacemaker implantation was required in 3 patients and ventricular perforation (by pacing lead) occurred in 1 patient, requiring surgery. After a follow-up of 12.3 years (11.0-13.5 years), 2 patients (4.4%) died from cardiac causes (heart failure and posttransplantation), 3 patients required an implantable cardioverter-defibrillator (1 for primary prevention and 2 due to sustained ventricular tachycardia after cardiac surgery), and 2 underwent cardiac surgery (due to endocarditis and mitral regurgitation). In the last clinical review, functional class was I-II in 39 patients (86.6%) (P.0001), the peak resting gradient was 16 (23) mmHg (P.0001), and mitral regurgitation was absent or mild in 34 patients (75.5%) (P.03).The results of this study suggest that septal ablation is safe and effective in the very long term. The procedure was not associated with a significant incidence of sudden death or symptomatic ventricular arrhythmias.

Resumen Introduccion y objetivos La ablacion septal percutanea es una alternativa terapeutica en la miocardiopatia hipertrofica obstructiva. Debido a su introduccion relativamente reciente, no hay informacion sobre eficacia y seguridad a muy largo plazo. Este estudio multicentrico evalua sus resultados en seguimiento superior a 10 anos. Metodos Se incluyo consecutivamente a pacientes tratados con ablacion septal en cinco centros entre 1998 y 2003. Se han analizado datos clinicos, hemodinamicos y ecocardiograficos basales y de seguimiento. Resultados Se ha incluido a 45 pacientes (media de edad, 62,4 ± 14 anos), de los que 31 eran mujeres y 39 (86,6%) estaban en clase funcional III - IV . El grosor del septo era 21,8 ± 3,5 mm; el gradiente maximo basal por ecocardiografia, 77 ± 39 mmHg, y la insuficiencia mitral era de grado al menos moderado en 22 pacientes (48,8%). Durante la hospitalizacion, 3 casos precisaron implante de marcapasos definitivo y 1 paciente sufrio perforacion ventricular por electrodo de marcapasos, que requirio cirugia. Tras seguimiento de 12,3 (11,0-13,5) anos, 2 pacientes (4,4%) sufrieron muerte cardiaca (insuficiencia cardiaca y postrasplante); 3, implante de desfibrilador automatico implantable (1 caso por prevencion primaria y 2 por taquicardia ventricular sostenida tras cirugia cardiaca), y 2, cirugia cardiaca (endocarditis e insuficiencia mitral). En la ultima evaluacion clinica, la clase funcional era I - II en 39 (86,6%) (p Conclusiones Estos resultados a mas de 10 anos indican seguridad y eficacia a muy largo plazo para la ablacion septal. No hubo incidencia significativa de arritmias ventriculares sintomaticas o muerte subita.