Percutaneous Tricuspid Valve Replacement: Two Cases of Valve-in-Valve and Valve-in-Ring

Abstract

Tricuspid valve replacement via transcatheter techniques is feasible but not yet widely utilized. These case reports describe transcatheter replacement of 1) a failing bioprosthetic tricuspid valve and 2) a failing native valve that had previously undergone surgical annuloplasty repair.  The first case is that of a 26-year-old male with Ebstein’s anomaly who had undergone surgical tricuspid valve replacement with a 33 mm Hancock bioprosthesis 15 years prior to transcatheter intervention.  This valve had become stenotic and regurgitant and was successfully replaced with a Melody valve (Medtronic Inc) mounted on a 22 mm Ensemble balloon in balloon system.  The second case is that of a 59-year-old female with rheumatic heart disease who had undergone prior surgical tricuspid valve repair with a 30 mm Edwards incomplete annuloplasty ring. Her repaired valve had eventually become severely regurgitant and she underwent successful transcatheter valve replacement using a 29 mm Sapien XT valve (Edwards Lifesciences).  She exhibited paravalvular regurgitation necessitating vascular plug implantation. These two cases highlight the potential utility and limitations of commercially available transcatheter valves in the tricuspid position.  Moreover, this report compares and contrasts the procedural nuances of tricuspid valve replacement within a complete bioprosthetic valve ring versus an open annuloplasty ring.