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31.03.2021 | review article | Ausgabe 15-16/2021 Open Access

Wiener klinische Wochenschrift 15-16/2021

Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction

Wiener klinische Wochenschrift > Ausgabe 15-16/2021
Varius Dannenberg, MD Carolina Donà, MD Matthias Koschutnik, MD Max-Paul Winter, MD Christian Nitsche, MD, PhD Andreas A. Kammerlander, MD, PhD Philipp E. Bartko, MD Christian Hengstenberg, MD Julia Mascherbauer, MD, PhD Georg Goliasch
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The online version of this article (https://​doi.​org/​10.​1007/​s00508-021-01842-x) contains supplementary material, which is available to authorized users.

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Valve degeneration after surgical tricuspid valve replacement or repair is frequent and may require repeat replacement/repair. For high-risk patients, transcatheter valve-in-valve and valve-in-ring procedures have emerged as valuable treatment alternatives. Preprocedural transthoracic echocardiography is the method of choice to detect malfunction of the prosthesis including degenerative stenosis and/or regurgitation requiring reintervention. Subsequently, computed tomography is helpful for detailed anatomical analysis and periprocedural planning. Device selection and sizing depend on the size and structural details of the implanted ring or prosthesis. The procedure is mainly guided by fluoroscopy; however, transesophageal echocardiography provides complementary guidance during device implantation. Preferred access route is the right femoral vein but in cases of more horizontal implants a jugular approach might be feasible. Suitable transcatheter valves are the Edwards Sapien 3 and the Medtronic Melody valves. Differences in surgical prostheses or annuloplasty implants are important for device selection, height consideration and additional ballooning prior to or after implantation. Transesophageal echocardiography postimplantation is convenient for the assessment of transvalvular gradients or paravalvular leaks.

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Supplemental video 1: Preprocedural 3D transesophageal echocardiography of the tricuspid valve from the atrial side, showing a degenerated bioprosthesis with restricted opening.
Supplemental video 2: Preprocedural color Doppler 3D transesophageal echocardiography of the bioprosthesis with a significant central regurgitant jet.
Supplemental video 3: Fluoroscopic movie displaying the deployment of the transcatheter valve in the degenerated bioprosthesis.
Supplemental video 4: Final fluoroscopic result of the deployed transcatheter valve.
Supplemental video 5: Identical image acquisition as displayed in supplemental video 1 at the end of the procedure displaying the deployed transcatheter valve.
Supplemental video 6: Postprocedural color Doppler biplane acquisition, showing a well-functioning valve without valvular or paravalvular regurgitation.
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