Page 32 - Journal of Structural Heart Disease Volume 3, Issue 5

Case Report
158
Here, we report the use of the tricuspid valve-in- valve implantation super-sti guidewire for rapid pacing during implantation of the valve.
Case Presentation
A 57-year-old woman underwent mechanical aortic valve and mitral valve replacement and bio-prosthet- ic tricuspid valve replacement (27 mm Carpentier-Ed- wards, CE) in 2006 due to rheumatic heart disease. With time, she gradually developed severe stenosis of the tricuspid bio-prosthesis. The mean and peak pres- sure gradients over the tricuspid bio-prosthetic valve were 26 and 35 mmHg, respectively, with normal left ventricular and right ventricular systolic function as evaluated by echocardiography. She complained of shortness of breath with mild e ort and edema of her legs. Her functional capacity was assessed as NYHA III-IV/IV.
During pre-procedural evaluation, the patient had a body weight of 62 kg and height of 155 cm,
blood creatinine 0.73 mg %, and an estimated glomerular filtration rate of 83 ml/min. The patient had a logistic EUROSCORE-II of 4% and STS scores of 2.1% for mortality and 17.9% for morbidity/ mortality.
Considering the patient’s high risk in re-opera- tion, we decided to proceed to tricuspid valve-in- valve implantation. The procedure was performed with the patient under deep sedation. Using a JR4 catheter, the tricuspid valve was crossed with a long hydrophilic wire that was advanced to the left pul- monary artery. The wire was replaced by an Amplatz super-sti 0.035’’ wire. An Edwards Sapien S3 26 mm valve was positioned over the wire in the bio-pros- thetic tricuspid valve. After advancing the transcath- eter tricuspid valve implantation (TTVI) system to the implantation position, an external cardiac pacemaker was connected to the guidewire. One electrode of the pacemaker was connected to the Amplatz su- per-sti wire (Figure 1), and the other electrode was connected to a large suture needle that was placed
Figure 1. Pacemaker electrode (thick arrow) connected to the Amplatz super-sti guidewire (thin arrows).
Journal of Structural Heart Disease, October 2017 Volume 3, Issue 5:157-162