Title: Percutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis
Abstract: HomeCirculationVol. 114, No. 18Percutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBPercutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis Kei Yunoki, MD, Takahiko Naruko, MD, Akira Itoh, MD, Junko Ohashi, MD, Kohei Fujimoto, MD, Naoya Shirai, MD, Koichi Shimamura, MD, Ryushi Komatsu, MD, Yuji Sakanoue, MD and Kazuo Haze, MD Kei YunokiKei Yunoki From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Takahiko NarukoTakahiko Naruko From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Akira ItohAkira Itoh From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Junko OhashiJunko Ohashi From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Kohei FujimotoKohei Fujimoto From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Naoya ShiraiNaoya Shirai From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Koichi ShimamuraKoichi Shimamura From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Ryushi KomatsuRyushi Komatsu From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. , Yuji SakanoueYuji Sakanoue From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. and Kazuo HazeKazuo Haze From the Department of Cardiology, Osaka City General Hospital, Osaka, Japan. Originally published31 Oct 2006https://doi.org/10.1161/CIRCULATIONAHA.106.618611Circulation. 2006;114:e558–e559A 59-year-old woman was admitted to our hospital because of exertional dyspnea, abdominal distension, and leg edema over the past 2 weeks. She had a history of rheumatic fever at the age of 12 years. In 1983, at the age of 37, she had undergone tricuspid valve replacement with a Carpentier-Edwards bioprosthesis for tricuspid stenosis and mitral valve replacement with a mechanical valve for mitral stenosis. The physical examination on admission revealed marked edema in both legs. There was also presystolic pulsation of the liver, which was palpable 4 cm below the right costal margin. A Levine grade III/VI, rough, diastolic rumble at the lower left sternal border was accentuated during inspiration. Echocardiography revealed severe tricuspid stenosis and a large amount of ascites. The leaflets were thickened, shortened, and immobile, resulting in a fixed orifice in systole and diastole. The mean diastolic gradient across the tricuspid valve was 14.1 mm Hg, with a peak gradient of 23.0 mm Hg during early diastole (Figure 1A). Tricuspid regurgitation was mild (Figure 1B and online-only Data Supplement Movie I), and there was no aortic or mitral valve pressure gradient. Initial therapy consisted of a diuretic for right-sided heart failure, but it did not relieve her ascites or leg edema. Therefore, we performed percutaneous transcatheter balloon valvuloplasty to reduce the gradient across the bioprosthetic tricuspid valve (Figure 2A and 2B and Movies II and IIII). During right heart catheterization, the right atrial tracing revealed a prominent A wave (24 mm Hg), with a mean diastolic gradient across the tricuspid valve of 13 mm Hg (Figure 2C). After the balloon valvuloplasty, the mean diastolic gradient across the tricuspid valve decreased to 6 mm Hg (Figure 2D). Echocardiography showed that the mean diastolic gradient across the tricuspid valve decreased to 7.0 mm Hg without worsening of tricuspid regurgitation (Figure 1C and 1D and Movie IV). The patient's symptoms immediately improved and the ascites disappeared. The present report demonstrates the successful use of percutaneous transcatheter balloon valvuloplasty for bioprosthetic tricuspid valve stenosis. Download figureDownload PowerPointFigure 1. A, Color flow imaging in an apical 4-chamber view shows the tricuspid stenosis jet and the tricuspid jet velocity, recorded with continuous-wave Doppler. The jet velocity of 2.4 m/s corresponded to a maximum transtricuspid pressure gradient of 23.0 mm Hg and a mean gradient of 14.1 mm Hg. B, Before the procedure, color flow imaging in the apical 4-chamber view showed mild tricuspid regurgitation (Movie I). RV indicates right ventricle; RA, right atrium. C, After balloon valvuloplasty, the maximum transtricuspid pressure gradient decreased from 23.0 mm Hg to 13.0 mm Hg and the mean gradient decreased from 14.1 mm Hg to 7.0 mm Hg. D, After the procedure, color flow imaging in the apical 4-chamber view showed no worsening of tricuspid regurgitation (Movie IV).Download figureDownload PowerPointFigure 2. A, Fluoroscopic image in the right anterior oblique/cranial view demonstrates the guide wire that was passed through the center of the stenotic bioprosthetic valve (Movie II). Mechanical mitral valve (black arrow) and bioprosthetic tricuspid valve (yellow arrow) are shown. B, Balloon valvuloplasty was performed with the use of a balloon with a maximum diameter of 25 × 40 mm and an inflation pressure of 16 atm (Movie III). C, Before the procedure, the mean right atrial pressure was 21 mm Hg and the right ventricular end-diastolic pressure was 5 mm Hg. The mean diastolic gradient across the tricuspid valve was 13 mm Hg. D, After the procedure, the mean right atrial pressure was 12 mm Hg and the right ventricular end-diastolic pressure was 10 mm Hg. The mean diastolic gradient across the tricuspid valve was improved to 6 mm Hg. Abbreviations as in Figure 1.The online-only Data Supplement, which includes 4 movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/18/e558/DC1.DisclosuresNone.FootnotesCorrespondence to Takahiko Naruko, MD, Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka, 534–0021, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hirata K, Tengan T, Wake M, Takahashi T, Ishimine T, Yasumoto H, Nakasu A, Mototake H, Tan T, Bonaros N, Rodríguez-Zanella H, Aziz A and Patel P (2019) Bioprosthetic tricuspid valve stenosis: a case series, European Heart Journal - Case Reports, 10.1093/ehjcr/ytz110, 3:3, Online publication date: 1-Sep-2019. Rana G, Malhotra R, Sharma A and Kakouros N (2017) Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis, Texas Heart Institute Journal, 10.14503/THIJ-15-5408, 44:1, (43-49), Online publication date: 1-Feb-2017. Yokoyama Y, Abe M, Fujieda H and Abe Y (2015) A rare case: bioprosthetic tricuspid valvuloplasty dramatically improved hepatic encephalopathy, General Thoracic and Cardiovascular Surgery, 10.1007/s11748-015-0532-0, 64:10, (618-620), Online publication date: 1-Oct-2016. Paul B, Biswas P and Majumder B (2015) A rare combination of rheumatic mitral and tricuspid stenosis treated by percutaneous balloon valvuloplasty, Journal of Indian College of Cardiology, 10.1016/j.jicc.2014.10.006, 5:1, (32-34), Online publication date: 1-Mar-2015. 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Petrou E, Vartela V, Girasis C, Boutsikou M, Iakovou I and Pavlides G (2014) Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis, Korean Circulation Journal, 10.4070/kcj.2014.44.2.128, 44:2, (128), . Hamatani Y, Saito N, Tazaki J, Natsuaki M, Nakai K, Makiyama T, Sasaki Y, Imai M, Watanabe S, Shioi T, Kimura T and Inoue K (2012) Percutaneous balloon valvuloplasty for bioprosthetic mitral valve stenosis, Heart and Vessels, 10.1007/s00380-012-0309-7, 28:5, (667-671), Online publication date: 1-Sep-2013. October 31, 2006Vol 114, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.618611PMID: 17075017 Originally publishedOctober 31, 2006 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsHeart FailureValvular Heart Disease