Elsevier

Canadian Journal of Cardiology

Volume 29, Issue 8, August 2013, Pages 1014.e3-1014.e4
Canadian Journal of Cardiology

Case Report
Transfemoral Access for Valve in Valve Implantation of an Edwards Sapien XT Valve in a Stenotic Tricuspid Bioprosthesis Under Fluoroscopic Guidance

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Abstract

A 53-year-old man presented with a high grade stenotic tricuspid bioprosthesis and an inoperable state because of progressive lung disease. Valve replacement was performed transfemorally under local anaesthesia without rapid pacing. Valve positioning was facilitated by the radiopaque frame of the degenerated bioprosthesis. Echocardiography revealed a decrease of peak tricuspid valve gradient from 18 to 8 mm Hg. Valve-in-valve implantation of an Edwards Sapien XT valve in a failing tricuspid bioprosthesis is feasible via transfemoral access without general anaesthesia or rapid pacing.

Résumé

Nous présentons le cas d'un homme de 53 ans ayant une bioprothèse pour une sténose tricuspidienne de haut degré et ne pouvant subir de chirurgie en raison d'une maladie pulmonaire progressive. Le remplacement valvulaire a été réalisé par voie transfémorale sous anesthésie locale sans stimulation rapide. Le positionnement de la valve a été facilité par l'opacité aux radiations de la bioprothèse dégénérée. L'échocardiographie a révélé une diminution du gradient maximal de la valve tricuspide de 18 à 8 mm Hg. L'implantation de type valve-in-valve d'une valve Edwards SAPIEN XT dans la bioprothèse tricuspide défaillante est réalisable par voie transfémorale sans anesthésie générale ou stimulation rapide.

Section snippets

Case Report

Transcatheter valve-in-valve strategies for degenerated bioprostheses are increasingly used because repeat surgery implies an elevated risk and technical challenges. Here, we report the case of a 53-year-old male patient with progressive interstitial lung disease because of hypersensitivity pneumonitis. Recently, a high-grade stenosis was diagnosed in the tricuspid bioprosthesis (Shelhigh NR900A, 31 mm), which was implanted in the year 2004 because of postendocarditic regurgitation. Tricuspid

Discussion

Valve-in-valve strategies are being increasingly applied as a remedy for degenerated bioprostheses. Though valve-in-valve strategies have been preferentially used in degenerated aortic bioprostheses, few publications exist for degenerated tricuspid bioprostheses. Implantation via the transjugular,1, 2 trans-atrial,3 and transfemoral4 access routes has been reported. However, this is the first report of valve-in-valve implantation in a degenerated tricuspid bioprostheses using local anaesthesia

Disclosures

The authors have no conflicts of interest to disclose.

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