Right ventricular afterload mismatch after transcatheter caval valve implantation for tricuspid regurgitation

An 81-year-old woman was referred to our institution because of refractory heart failure. She had a history of arterial hypertension, permanent atrial fibrillation, dyslipidemia, chronic obstructive pulmonary disease as a former smoker, stage IV chronic kidney disease, hepatic steatosis, previous smoking, and osteoporosis. Brain natriuretic peptide was 848pg/ml, serum creatinine was 2mg/dl, and liver enzymes were within normal limits. Chest X-ray showed pulmonary edema. Thetransthoracic echocardiogram(TTE)showedamildlyhypertrophicleftventriclewith preserved ejection fraction and diastolic dysfunction.