PMC9259371_01
Transthoracic echocardiography (TTE) and Doppler before the operation: bioprosthetic tricuspid valve calcification (white arrow) and stenosis (a, b). Bioprosthetic maximal velocity 2.7 m/s (c). The foramen ovale opening (white arrow) (d).
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fig1
TV stenosis (Figure 1).
Cardiac computed tomography images: distribution of severe bioprosthetic leaflet calcification (a). Inner diameter of the bioprosthetic valve (26.3 mm) (b). The best projection angles (c).
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fig2
The tricuspid annular plane systolic excursion was 8 mm, and the fractional area change (FAC) was 40%. The distribution of severe calcification in the bioprosthetic valve and the bioprosthesis annulus's diameter were determined by multidetector computed tomography (MDCT) (Figure 2).
Step-by-step transatrial TVIV implantation of the J-valve. The right atrium puncture according to the coaxial position of the tricuspid annulus (a). The three "U-shape graspers" were released and embraced the prior bioprosthetic struts (white arrow) (b). Full deployment of the J-valve (c).
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fig3
The J-valve was reversely loaded on the conveyor system and successfully implanted into the degenerated bioprosthesis. The three "U-shape graspers" were released and embraced the prior bioprosthetic struts (Figure 3).
The transthoracic echocardiogram images during the 34-month follow-up period: TTE showed optimal valve position and well hemodynamic status (a, b). TTE with color flow showed a maximal velocity of 1.6 m/s (c).
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fig4
Thirty-four months after surgery, the patient was free of heart failure symptoms and the echocardiogram suggested excellent hemodynamics of the bioprosthetic valve (Figure 4).