Is this procedure surgery?

It is not open-heart surgery: the chest is not opened and the heart is not stopped. It is a catheter-based procedure performed through the vein in the groin.

Is everyone suitable for this procedure?

No. Suitability depends on the structure of the valve leaflets, the type of leak and the quality of the echo images; having a pacemaker lead can also affect the assessment. The decision is made with the heart team after a detailed echocardiography assessment.

Will the leak go away completely?

The aim is to reduce the leak. How much it lessens depends on the structure of the valve, and in some patients some leakage may remain. The result is checked with echocardiography during the procedure.

Can I stop my medications after the procedure?

Do not stop them on your own. Your water tablets (diuretics) and other heart medications continue as your doctor advises; their doses may be adjusted after the procedure.

In case of sudden chest pain, shortness of breath or fainting, call 112.

Catheter-based repair of a leaking tricuspid valve

The leaflets of a leaking tricuspid valve are brought together with one or more clips, placed using a catheter advanced through the vein in the groin. The chest is not opened; the aim is to reduce the leak.

What is it?

The tricuspid valve lies on the right side of the heart, between the right atrium and the right ventricle. When the right ventricle contracts, the valve closes so that blood is pumped to the lungs. If the valve does not close fully, some blood leaks backward into the right atrium with every heartbeat. This is called tricuspid regurgitation, or a leaking tricuspid valve. The leak is most often caused by enlargement of the right side of the heart and of the ring around the valve. This enlargement can be linked to conditions such as left-sided heart disease, high blood pressure in the lungs or atrial fibrillation. When the leak is severe, blood returning from the body to the heart backs up. Swollen legs, a swollen abdomen, tiredness, loss of appetite and tiring easily on exertion may occur. In catheter-based edge-to-edge repair, the valve is reached with a catheter advanced through the vein in the groin. One or more clips bring the valve leaflets together, and the backward leak lessens. Because the right atrium can be reached directly through the veins, there is no need to cross the wall between the atria, unlike mitral valve repair. Catheter-based tricuspid valve repair is a relatively new and developing field of treatment, and its long-term results are still being studied. For this reason, suitability for the procedure is decided through a detailed echocardiography assessment and a heart team review. Prof. Dr. Barış Kılıçaslan performs catheter-based valve treatments, including catheter-based tricuspid valve repair, in his clinical practice.

Who is it for?

Patients with severe tricuspid regurgitation whose symptoms, such as swelling or tiredness, continue despite medical treatment including water tablets (diuretics)
Patients for whom open-heart surgery carries a high risk, or who are not suitable for surgery
The valve must be found suitable for repair on detailed echocardiography; the decision is made by a heart team of cardiologists and cardiac surgeons

Before the procedure

Before the procedure the structure of the valve, the severity of the leak and the condition of the right ventricle are examined in detail with echocardiography. An echo performed through the gullet (transoesophageal echocardiography, TOE) is important in showing whether the valve is suitable for repair with a clip. If you have a pacemaker or defibrillator lead, its relationship to the valve is also assessed. If needed, other tests are carried out, such as right heart catheterisation to measure the pressure in the lung arteries. Your medications, especially blood thinners and water tablets (diuretics), are reviewed with your doctor before the procedure. Do not stop any medication on your own. Because the procedure is usually done under general anaesthesia, you will be asked not to eat or drink for a period beforehand; you will be told how long.

How is it done?

Anaesthesia and imaging: The procedure is usually done under general anaesthesia. An echo probe passed through the gullet (TOE) shows the valve live throughout the procedure.
Access: A thin sheath is placed in the vein in the groin (the femoral vein). Through it, the catheter is advanced to the right atrium; there is no need to cross the wall between the atria.
Reaching the valve: Guided by echo and live X-ray imaging, the clip is steered to the tricuspid valve and brought to the area of the leak.
Bringing the leaflets together: The clip is opened, grasps the valve leaflets and closes to bring them together. More than one clip may be needed to reduce the leak enough.
Check and closure: Echocardiography is used to check how much the leak has lessened and whether the valve has become narrowed. When the result is found appropriate, the clip is released, the catheter is removed and the access site is closed.

Recovery

After the procedure you are woken from anaesthesia and closely monitored for a while. The access site in the groin is checked for bleeding. The timing of discharge depends on your general condition and the access site. After discharge the valve is followed with regular check-ups and echocardiography. Your doctor may adjust the doses of your water tablets (diuretics) and other heart medications according to how you are after the procedure. Tell your doctor at your check-ups about any changes in symptoms such as swelling or tiredness.

Risks

Like every interventional procedure, this procedure has risks. Possible complications include bleeding or bruising at the access site, the clip coming loose from a leaflet or moving, narrowing of the valve, and heart rhythm disturbances. Serious complications such as fluid collecting around the heart are rare. Your doctor will explain the possible benefits and risks for you in detail, based on your personal situation, before the procedure.

Frequently asked questions

Is this procedure surgery? It is not open-heart surgery: the chest is not opened and the heart is not stopped. It is a catheter-based procedure performed through the vein in the groin.
Is everyone suitable for this procedure? No. Suitability depends on the structure of the valve leaflets, the type of leak and the quality of the echo images; having a pacemaker lead can also affect the assessment. The decision is made with the heart team after a detailed echocardiography assessment.
Will the leak go away completely? The aim is to reduce the leak. How much it lessens depends on the structure of the valve, and in some patients some leakage may remain. The result is checked with echocardiography during the procedure.
Can I stop my medications after the procedure? Do not stop them on your own. Your water tablets (diuretics) and other heart medications continue as your doctor advises; their doses may be adjusted after the procedure.

Medical content reviewed and approved by Prof. Dr. Barış Kılıçaslan. Last updated: 4 October 2026. Editor: Baran Zeydan (info@clinixcrm.app).