PMC9449311_01
Degenerated bioprosthesis with complete frame. (A) Transthoracic echocardiography shows severe pulmonary regurgitation; (B) Angiography reveals severe pulmonary insufficiency; (C) The annular size calculated on computed tomography.
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F1
However, dysfunctional bioprosthesis was still detected by TTE with thicken leaflet, severe pulmonary regurgitation 3 years later (Figure 1A; Supplementary Video 1), moderate to severe tricuspid insufficiency and right heart dilation. Severe pulmonary insufficiency appeared on angiography (Figure 1B; Supplementary Video 2). Since the annular size of 25.9 mm calculated on computed tomography and three-dimension reconstruction (Figure 1C), a P28-25 mm (diameter-length) self-expandable Venus P-valve (Venus Medtech, Hangzhou, China) with 22-F delivery system was planned to be deployed.
Transcatheter pulmonary valve-in-valve implantation for degenerated bioprosthesis. (A,B) The delivery system crossed the degenerated bioprostheses with the assistance of modified buddy wire; (C,D) The result of transcatheter valve-in-valve implantation with no pulmonary regurgitation.
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F2
The 14-F Cook sheath served as modified buddy wire providing extra support and straightening the vessel and the RVOT (Figure 2A). The new self-expanding valve was then successfully delivered (Figure 2B) and implanted. TTE showed no pulmonary regurgitation (Figures 2C,D, 3; Supplementary Videos 3, 4). Then pulmonary pressure was raised to 35/18 mmHg.
Timeline of events of the patient.
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F3
TTE showed no pulmonary regurgitation (Figures 2C,D, 3; Supplementary Videos 3, 4). Then pulmonary pressure was raised to 35/18 mmHg. TPVI with improved symptoms of heart failure (Figure 3). TTE was obtained and showed a persistently good valve function.