title: How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?
abstract: BACKGROUND
  A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.
  
  
  METHODS
  Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography.
  
  
  METHODS
  She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure.
  
  
  METHODS
  A transcatheter 26 mm Edwards SAPIEN valve was placed in the tricuspid position, resulting in near normalisation of tricuspid valve gradient. This represents the first report of a combined valve-in-ring (VIR) and valve in a homograft valve (VIV) SAPIEN implantation.
authors.affiliation: Division of Cardiovascular Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lilly
authors.forename: Jack
authors.initials: J
authors.lastname: Rome
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Satya
authors.initials: S
authors.lastname: Shreenivas
authors.forename: Nimesh
authors.initials: N
authors.lastname: Desai
authors.forename: Frank E
authors.initials: FE
authors.lastname: Silvestry
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Amir
authors.initials: A
authors.lastname: Fassa
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Labbé
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hvass
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Noa
authors.initials: N
authors.lastname: Holoshitz
authors.forename: Damien
authors.initials: D
authors.lastname: Kenny
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014264:Tricuspid Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*