Severe TR and heart failure in a patient with Tetralogy of Fallot repair and multiple pulmonary stenting and conduit interventions treated with Trans-jugular TTVR after dilatation of jugular vein stenosis stenosis
Presenter
Camil Succar, MD, The University of British Columbia, Vancouver, BC, CANADA
Camil Succar, MD, The University of British Columbia, Vancouver, BC, CANADA
Keywords: Congenital Heart Disease (CHD), Peripheral Vascular Disease (PVD), Structural Heart Disease (SHD), TTVR/Tricuspid Valve and Venous Disease
Title
Severe TR and heart failure in a patient with Tetralogy of Fallot repair and multiple pulmonary artery stenting and conduit interventions treated with Trans-jugular TTVR after dilatation of jugular vein stenosis stenosis
Introduction
47F with TOF s/p multiple pulmonary conduit interventions and pulmonary artery stenting presents with right sided HF and torrential TR. She also has a right sided pacemaker/ICD (implanted for heart block and VT) leading to right SVC stenosis.
Clinical Case
Discussion
within a Multidisciplinary Heart Team concluded that this is best managed via a transcatheter-intervention rather than very high risk surgery. The procedure included extraction of her cardiac device, dilatation of the SVC to allow for the insertion of the TTVR 33F delivery system trans-jugularly, TTVR with implantation of a 55mm LUX valve, stenting of the SVC stenosis, and insertion of a leadless pacemaker followed by an S-ICD.
The procedure was successful and the patient was no longer in HF. Discussion This case showcases the complexity of valvular heart disease management in adult patients with congenital heart disease after multiple cardiac interventions. It also stresses the importance of a coordinated multidisciplinary approach to such cases.