Complicated Percutaneous Valve in Ring, Valve in Valve and Vascular Plug for Treatment of Severe Tricuspid Regurgitation
Presenter
Manju Bengaluru Jayanna, MD, MSc, Bryn Mawr Medical Specialists, Bryn Mawr, PA
Manju Bengaluru Jayanna, MD, MSc, Bryn Mawr Medical Specialists, Bryn Mawr, PA
Title
Complicated Percutaneous valve in ring, valve in valve and Vascular plug for treatment of Severe tricuspid regurgitation
Introduction
- Patient with severe symptomatic tricuspid valve regurgitation have limited treatment options that are challenging.
- Percutaneous tricuspid valve interventions are an evolving area of structural heart interventions.
- Here we present a complex case of percutaneous valve in ring, valve in valve and Vascular plug for treatment of Severe tricuspid regurgitation
Clinical Case
77 yr old female who presented with severe tricuspid regurgitation -Sinus node dysfunction, pacer maker dependent, dual chamber pacemaker removed due to concern TR mediated by pacemaker. Single chamber coronary sinus pacer-too unstable, replaced with Medtronic Micra leadless pacemaker. H/o 32mm Tricuspid ring. H/o CABG. H/o TAVR. H/o Watchmann LAA closure.Now with symptoms of significant dyspnea with minimal activity, chronic fatigue, b/l lower extremity edema. Underwent procedure as described.
Discussion
- Severe paravalvular leak may complicate valve in ring percutaneous tricuspid valve intervention due to incomplete ring, despite pre procedural planning.
- Presence of leadless pacemaker in pacemaker dependent patients increases complexity of such interventions.
- Use of vascular plugs may help successfully treat the paravalvular leaks.