A 67-year-old man with congenital correct transposition of great arteries and previous surgical aortic valve replacement for severe stenosis. He was referred to our center with heart failure symptoms in New York Heart Association functional class IV. Transthoracic echocardiography demonstrated, severe tricuspid valve stenosis, and biventricular dysfunction. The computed tomography (CT) scan showed diffuse tricuspid annular calcifications (Figure 1). Due to multiple comorbidities (diabetes, stage 3 chronic kidney disease, chronic obstructive pulmonary disease), the patient was ineligible for surgical valve intervention or transplantation. We discussed with the patient the option of transcatheter valve implantation in the tricuspid calcific annular frame, presuming a favorable risk–benefit tradeoff. The CT scan showed a tricuspid annular area of 704.2 mm2. The CT scan dataset was used to create a 3-dimensional (3D) reconstruction of the tricuspid ring, interatrial septum, and both atria and the ventricles. The procedure was performed by venous femoral access and was guided by both fluoroscopy, with the overlay of the 3D-CT (Figure 2). The 3D reconstruction allowed us to understand the height for optimal transseptal puncture site to have the best orientation to convey the balloon-expandable valve inside the tricuspid ring. The 3D CT overlay allowed us to not use dye during the procedure (Videos 1 to 4). An overfilled (33 + 4 mL) 29-mm SAPIEN3 Valve (Edwards Lifesciences) was implanted. At the end of the procedure, the valve was stable without gradient across, paravalvular leak, or regurgitation (Video 5). Slow inflation of the balloon during valve implantation minimizes the risk of annular damage. To our knowledge, we describe the first case of a transcatheter balloon-expandable valve implanted in a systemic tricuspid valve using the tricuspid annular calcification as an anchor.
D'Aiello, A.F., De Marco, F., Ferrero, P., Pasqualin, G., Di Dedda, U., Giamberti, A., et al. (2022). Balloon-Expandable Valve Implantation in a Systemic Tricuspid Valve With Annular Calcification Using 3D CT Overlay. JACC: CARDIOVASCULAR INTERVENTIONS, 15(22), 233-235 [10.1016/j.jcin.2022.08.055].
Balloon-Expandable Valve Implantation in a Systemic Tricuspid Valve With Annular Calcification Using 3D CT Overlay
Pasqualin G.;
2022
Abstract
A 67-year-old man with congenital correct transposition of great arteries and previous surgical aortic valve replacement for severe stenosis. He was referred to our center with heart failure symptoms in New York Heart Association functional class IV. Transthoracic echocardiography demonstrated, severe tricuspid valve stenosis, and biventricular dysfunction. The computed tomography (CT) scan showed diffuse tricuspid annular calcifications (Figure 1). Due to multiple comorbidities (diabetes, stage 3 chronic kidney disease, chronic obstructive pulmonary disease), the patient was ineligible for surgical valve intervention or transplantation. We discussed with the patient the option of transcatheter valve implantation in the tricuspid calcific annular frame, presuming a favorable risk–benefit tradeoff. The CT scan showed a tricuspid annular area of 704.2 mm2. The CT scan dataset was used to create a 3-dimensional (3D) reconstruction of the tricuspid ring, interatrial septum, and both atria and the ventricles. The procedure was performed by venous femoral access and was guided by both fluoroscopy, with the overlay of the 3D-CT (Figure 2). The 3D reconstruction allowed us to understand the height for optimal transseptal puncture site to have the best orientation to convey the balloon-expandable valve inside the tricuspid ring. The 3D CT overlay allowed us to not use dye during the procedure (Videos 1 to 4). An overfilled (33 + 4 mL) 29-mm SAPIEN3 Valve (Edwards Lifesciences) was implanted. At the end of the procedure, the valve was stable without gradient across, paravalvular leak, or regurgitation (Video 5). Slow inflation of the balloon during valve implantation minimizes the risk of annular damage. To our knowledge, we describe the first case of a transcatheter balloon-expandable valve implanted in a systemic tricuspid valve using the tricuspid annular calcification as an anchor.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
