PMC6433773_01
The echocardiography shows a degeneration of tricuspid biological prosthesis with severe regurgitation (A) and stenosis (B).
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Echocardiographic examination showed tricuspid prosthesis degeneration with both severe stenosis and regurgitation (Figure 1).
The implantation of an aortic balloon expandable biological valve into a degenerated tricuspid biological prosthesis. A Swan Ganz catheter with an angiographic 0.035' wire crosses the tricuspid degenerated prosthesis (A). A balloon valvuloplasty is performed, even if no mandatory in valve in valve procedure. The first balloon inflation shows a residual stenosis (B), the second inflation shows a successful balloon expansion. The valvuloplasty is also performed to confirm the degenerated bioprosthesis size (C). An aortic balloon expandable biological valve, a device normally used for aortic valve replacement, crosses the tricuspid degenerated prosthesis (D). The guidewire is placed in right ventricle to achieve a perfect alignment between transcatheter valve and degenerated bioprosthesis despite the horizontal right chamber axis. The valve is deployed using a 3D transesophageal echocardiography (TEE) reconstruction and right atrial angiography to control the release (E). The final right ventricular angiography shows no residual regurgitation after valve in valve implantation (F).
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Edwards Balloon), (Figure 2). Even if pre-dilatation of the prosthesis is not mandatory in valve in valve procedures, we have decided to perform a balloon valvuloplasty to confirm the bioprosthesis valve size and to visualize a fluoroscopy invisible bioprosthesis. TEE allowed for reliable visualization of Liotta prosthesis, we decided to inject contrast media through the left internal jugular access obtaining a right atrial angiography which allowed precisely to control the valve in valve deployment (Figure 2; Supplementary Video 1). The TEE post procedure showed no regurgitation and no stenosis of the tricuspid valve (Figure 3).
The 3D transesophageal echocardiography (TEE) post procedure shows the normal function of the tricuspid valve. The 3DTEE post procedure shows the absence of regurgitation (A), stenosis (B), and the 3D reconstruction (C) of the tricuspid prosthesis after the valve in valve intervention.
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TEE allowed for reliable visualization of Liotta prosthesis, we decided to inject contrast media through the left internal jugular access obtaining a right atrial angiography which allowed precisely to control the valve in valve deployment (Figure 2; Supplementary Video 1). The TEE post procedure showed no regurgitation and no stenosis of the tricuspid valve (Figure 3).