title: Transcatheter Sapien valve implantation in a native tricuspid valve after failed surgical repair.
abstract: OBJECTIVE
  We describe the first report of a transcatheter Sapien implantation in a native tricuspid valve after multiple failed surgical repairs with a lack of prosthetic material and radiographic landmarks.
  
  
  RESULTS
  A 47-year old female underwent multiple valve repairs and replacements including three tricuspid valve repairs without surgical ring or bioprosthesis implantation. She developed signs of right heart failure associated with a mixed tricuspid disease combining a severe stenosis and regurgitation. After surgical turn down, a revalvulation using a transcatheter approach was attempted. The challenges in this case were the absence of a stiff region to anchor the percutaneous valve, the lack of radiographic landmarks and the difficulties of precise annulus measurements. The applied strategy was -under general anesthesia and extracorporeal membrane oxygenation-: balloon sizing, prestenting of the tricuspid annulus using covered stents followed by Sapien valve implantation through the femoral vein under fluoroscopy and transoesophageal echocardiography (TEE). The procedure was successfull, solving the tricuspid leak and stenosis (peak gradient from 22 to 3 mm Hg) using two Sapien for a perfect positioning. It was complicated by pulmonary bleeding due to a distal wire exit, treated successfully by coil embolization. The clinical and echocardiographic outcome was good up to 5 months.
  
  
  CONCLUSIONS
  Transcatheter Sapien valve implantation in a native tricuspid valve after failed multiple surgical repairs is feasible by the femoral vein. Technical challenges due to the lack of rigid landing zone and fluoroscopic markers were solved by prestenting and valve implantation under bi-plane fluoroscopic and TEE guidance.
authors: Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Division of Cardiology, Avenue Hippocrate 10-2881, Brussels, 1200, Belgium.
authors: Joelle
authors: J
authors: Kefer
authors: Thierry
authors: T
authors: Sluysmans
authors: Jean-Louis
authors: JL
authors: Vanoverschelde
mesh_terms: D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D017211:Treatment Failure; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014264:Tricuspid Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*
keywords: TAVI; valvular heart disease; valvuloplasty