Percutaneous valve-in-valve transcatheter tricuspid valve replacement with simultaneous paravalvular leak closure in a patient with refractory right heart failure.

A 38-year-old male patient presented to our hospital with a 3-month history of shortness of breath in combination with severe peripheral edema and ascites. Twenty-two years previously, he had undergone bioprosthetic tricuspid valve implantation due to Ebstein anomaly. Transthoracic echocardiography revealed significantly dilated right cardiac chambers, reduced right ventricular function, stenotic and degenerated bioprosthetic tricuspid valve, and marked tricuspid insufficiency associated with a 22-mm paravalvular defect located lateral to the valve (Fig. 1, Online Videos 1, 2, and 3). Cardiac computed tomography also revealed significantly dilated right cardiac chambers and a 24-mm defect located lateral to the valve.