Percutaneous Tricuspid Valve-in-Valve Implantation With Melon Seeding During Deployment.

BACKGROUND

Bioprosthetic tricuspid valves are prone to structural deterioration over time. In patients with multiple prior sternotomies and functioning left-sided prostheses, repeat surgery may carry prohibitive risk, prompting consideration of transcatheter alternatives.

CASE SUMMARY: A 42-year-old patient with rheumatic heart disease and a history of 3 prior sternotomies for mitral, aortic, and tricuspid valve replacement presented with recurrent admissions for diuretic-resistant right heart failure complicated by congestive hepatopathy (Child-Pugh B cirrhosis). Imaging demonstrated severe stenosis of a bioprosthetic tricuspid valve, with preserved left-sided valve function. The patient underwent successful percutaneous tricuspid valve-in-valve implantation, resulting in marked symptomatic improvement and significant reduction in transvalvular gradients on echocardiography.

DISCUSSION: Current guidelines support reintervention for symptomatic bioprosthetic valve dysfunction. In high surgical risk patients, percutaneous tricuspid valve-in-valve implantation represents an effective and less invasive alternative to repeat surgery.

TAKE-HOME MESSAGE: Percutaneous tricuspid valve-in-valve replacement is a viable therapeutic option for failed tricuspid bioprostheses in carefully selected high-risk patients.