Page 29 - Journal of Structural Heart Disease Volume 3, Issue 2

Case Report
Journal of Structural Heart Disease, April 2017, Volume 3, Issue 2:55-61
DOI: http://dx.doi.org/10.12945/j.jshd.2017.012.16
Received: October 19, 2016 Accepted: November 27, 2016 Published online: April 2017
Percutaneous Tricuspid Valve Replacement
Two Cases of Valve-in-Valve and Valve-in-Ring
Steve Zhou, BS1*, Jamil Aboulhosn, MD2
1 David Ge en School of Medicine, University of California Los Angeles, Los Angeles, California, USA
2 Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California, USA
Abstract
Tricuspid valve (TV) replacement via transcatheter techniques is feasible but not yet widely utilized. The two cases reported here describe transcatheter re- placement of a failing bioprosthetic TV and a failing native valve that previously underwent surgical annu- loplasty repair. The rst case was a 26-year-old male with Ebstein’s anomaly who underwent surgical TV replacement with a 33-mm Hancock bioprosthesis 15 years prior to transcatheter intervention. The valve had become stenotic and regurgitant and was successfully replaced with a Melody valve mounted on a 22-mm En- semble balloon-in-balloon system. The second case was a 59-year-old female with rheumatic heart disease who had undergone prior surgical TV repair with a 30-mm Edwards incomplete annuloplasty ring. Her repaired valve eventually became severely regurgitant, and she underwent successful transcatheter valve replacement using a 29-mm Sapien XT valve. She exhibited paraval- vular regurgitation necessitating vascular plug implan- tation. These two cases highlight the potential utility and limitations of commercially available transcathe- ter valves in the tricuspid position. Moreover, this re- port compares and contrasts the procedural nuances of TV replacement within a complete bioprosthetic valve ring versus an open annuloplasty ring.
Copyright © 2017 Science International Corp.
Key Words:
Tricuspid valve stenosis • Tricuspid valve insu ciency • Ebstein’s anomaly • Transcatheter valve replacement •
Right-sided heart failure • Cardiac valve annuloplasty • Heart valve prosthesis
Introduction
Native tricuspid valve (TV) dysfunction is associ- ated with both congenital and acquired heart con- ditions. Conditions such as severe pulmonary hyper- tension or right ventricular (RV) out ow obstruction can lead to elevated RV systolic pressure, commonly causing RV and TV annular dilation and subsequent tricuspid regurgitation (TR). Patients with congenital RV out ow dysfunction, such as repaired Tetralogy of Fallot with pulmonic stenosis and/or regurgitation, commonly develop secondary TR. Other congenital conditions associated with primary TV dysfunction include Ebstein’s anomaly, with regurgitation occur- ring due to dysplastic tricuspid lea ets. Although TR may be well tolerated for decades, eventual clinical sequelae usually emerge. These most commonly in- volve progressive RV dysfunction, the development of ventricular and supraventricular arrhythmias, and elevated central venous pressure leading to multi- -organ congestion.
TV repair techniques include the placement of annular rings as well as more complex operations to relocate or augment TV lea ets in patients with Ebstein’s anomaly. Repair is usually successful in the short and intermediate term, but up to 25% of
* Corresponding Author:
Steve Zhou, BS
David Ge en School of Medicine
University of California Los Angeles
885 Tiverton Drive, Los Angeles, California 90095, USA
Tel: +1 650 796 1026; Fax: +1 310 825 9012; E-Mail: szhou@mednet.ucla.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
Accessible online at:
http://structuralheartdisease.org/