Long-term Outcome of Simultaneous Transcatheter Pulmonary and Tricuspid Valve-in-Valve Implantation in Ebstein Malformation With Pulmonary Insufficiency

Combined transcatheter tricuspid valve replacement and pulmonary is limited to case reports. We reported a of simultaneous transfemoral valve-in-valve procedure using Edwards valves in 36-year-old male patient from the Kingdom Saudi Arabia with history bioprosthetic degeneration. also long-term outcomes this procedure. There are reports for surgical combined (TV) (PV) replacement, but mortality level be as high 10%-33%. This risk tends increase redo sternotomies.1Fukunaga N. Koyama T. Early late isolated surgery following valvular surgery.Ann Thorac Cardiovasc Surg. 2019; 25: 111-116Crossref PubMed Scopus (3) Google Scholar Limited studies outcome TV PV replacement. Herein, we report our experience percutaneous (VIV) implantation positions SAPIEN Ebstein malformation stenosis. Our was diagnosed an stenosis at 4 months age. At age 2, he underwent valvectomy repair. 28, presented symptoms right heart failure, ascites, dyspnea. Echocardiography showed severe regurgitation enlarged atrium (RA). His medical course complicated by atrial fibrillation, requiring rate control anticoagulation. He initially conservatively managed diuretics, followed 29-mm Carpentier-Edwards Magna (Edwards Life Sciences, Irvine, CA) position, 27-mm Perimount RA reduction, maze procedure, dual-chamber permanent pacemaker. 31, had large umbilical hernia, However, 1 week after repeated spikes fever. Repeated blood cultures, Q fever, brucellosis serology turned out negative. Follow-up transesophageal echo markedly dilated multiple thrombi. The prostheses appeared degenerative, intrinsic malcoaptation. mean inflow gradients were 17 mm Hg 5 Hg, respectively. ventricular (RV) systolic function moderately depressed, mild global hypokinesia left ventricle. Cardiac computed tomography (CT) angiography revealed severely coronary sinus (CS). thrombi largest thrombus measuring 31 × 33 seated within CS next 20 24 inferior vena cava junction RA. could not perform cardiac magnetic resonance imaging because pacemaker leads incompatible imaging. placed on coumarin therapy Serial echocardiograms that regressed finally disappeared, there progressive prosthetic regurgitation. 32, started developing New York Heart Association (NYHA) class III ascites lower limb oedema. time, European System Operative Risk Evaluation II 18.13%. Therefore, associated sternotomies, considered VIV discussion team. performed under general anaesthesia fluoroscopy guidance. Baseline haemodynamics gradient 13 across 15 (Table 1). Balloon testing performed, which internal diameter 26 PV.Table 1Procedure results implantationPreprocedureImmediate PostprocedureTricuspid valvePulmonary valveTricuspid valveTrans (mm Hg)Regurgitation degreeTrans degree13Severe15Severe2Nil2Nil Open table new tab size site neo chosen per mitral mobile app version 2.2 (http://www.ubqo.com/vivmitral). Following application, decided use 26-mm S3 position. Some difficulties encountered when accessing hugely An curve catheter helped us cross degenerated bioprothesis. Postprocedure no evidence or insufficiency (Videos 1-4 , view video online). Haemodynamics 2 prostheses, 1-year follow-up, transvalvular remained same 2). improvement during clinic visit (NYHA II).Table 2Clinical follow-up findings1 month follow up1 up12 up5 years upTricuspid valveInflow gradientRegurge degreeInflow degree4Nil2Nil2Nil5Nil2Mild12Nil Furthermore, observed. 5-year 12 observed, NYHA I symptoms. Transthoracic echocardiography Similarly, diagnostic catheterization significant implanted RV end diastolic pressure 7 his 8 V wave. Redo currently “gold standard” treatment bioprosthesis failure. provides alternative approach patients reoperation.1Fukunaga first described Jux et al.2Jux C. Akintuerk H. Schranz D. Two Melodies concert: double-valve replacement.Catheter Interv. 2012; 80: 997-1001Crossref (13) Melody valves, Baig al.3Baig M. Alli O. Davies J. Simultaneous failing bioprostheses.Catheter 2016; 87: 1352-1355Crossref valves. Adam al.4Small A.J. Aksoy Levi D.S. al.Combined replacement.World J Pediatr Congenit 2020; 11: 432-437Crossref (4) series medium-term patients. In contrast, report, describe its outcome. rapid deterioration specifically alarming. Several have highlighted effect subclinical leaflet thrombosis, CT scan, referred hypoattenuating thickening, may affect motion, hypoattenuation affecting motion.5Rosseel L. De Backer Søndergaard Clinical thrombosis aortic replacement: need patient-tailored antithrombotic therapy?.Front Med. 6: 44Crossref (49) case, abnormal due anomaly, fibrillation leading higher possible endocarditis attributed formation thus Tailoring anticoagulation such cases needs studied more. Before carrying several considerations should outlined. First, it important appropriate type, size, site. preferred their unique frame geometry stronger radial frame, withstand mechanical annular forces limit strain-related failure.6Sawaya F.J. Spaziano Lefèvre al.Comparison between XT valves: single-center experience.World Cardiol. 8: 735-745Crossref shorter than other including venous P beneficial avoid outflow tract (RVOT) obstruction. developed technology company UBQO Dr Vinayak Bapat (http://www.ubqo.com/vivmitral) assists selection based previously valve. Moreover, difference cell causes foreshorten more side.6Sawaya performer position prosthesis approximately 10% above sewing ring proximal portion 3 wrapped relatively long inner skirt (10.2 mm) smaller outer (7 polyethylene terephthalate sealing. foreshortening while mainly side around crimped height 28 expanded mm. After precaution, stent lies minimally pre-existing defective fluoroscopy. way seals up existing ensure mounted balloon via antegrade contrast mounting technique used It highly recommended start before disruption delivery sheath initially. dry seal (Gore, USA) crucial assist navigation protect crossing TV. Other Myval, successfully although still lacking.7Jensen R.V. Jensen J.K. Christiansen E.H. al.Two Sapien MyVal biological valves.Eur Case Rep. 2022; ytac131Crossref (2) Owing complex nature these cases, planning For that, scan determine relationship CS, RVOT, moderator band, angulation superior cava, (Supplemental Fig. S1). neo-bioprosthetic compromising RVOT. During planning, discussed possibility fracturing implantation. Although cracking would allowed considerably theoretically allow further interventions future, refrained doing so. reasons (1) already RA, believe overstretching result tears haemorrhage stretched atrium; breakage can lead eccentric displacement calcified surrounding tissue, artery close CS. treated eventually concerned microthrombus debris/pannus embolization mouth occur upon complicate implantation, carefully monitor any leak. Three types procedures paravalvular (leak native valve), intervalvular (regurgitation valves), leaks (leakage valve).6Sawaya incidents leakage overcome adding extra mL inflating balloon. High-pressure balloons cautiously quite sensitive overinflation holds addition, carries annulus, might compression block. Transcatheter has potential advantages over cost compensated short hospital LOS avoidance therapy. Published shown comparable midterm replacment vs terms freedom reintervention infective setting tetralogy Fallot Ross procedures.4Small cases. Further required compare longevity safer sternotomy bioprosthesis. recommend analysing data cohort multicentre study.Novel Teaching Points•Simultaneous (TPVR) (TTVR) feasible especially high-risk patients.•Although study required, shows good TPVR TTVR.