Percutaneous double balloon valvuloplasty for stenosis of porcine bioprostheses in the tricuspid valve position: A report of 2 cases

Abstract

The feasibility and results of percutaneous double balloon valvuloplasty were evaluated in 2 patients with stenosis of porcine bioprostheses in the tricuspid valve position. The procedures were performed with a Trefoil 3 x 10 and a 15 mm balloon. Long inflations (4 and 3 minutes) were well tolerated. A significant immediate increase in the valve area, without significant valvular regurgitation, was achieved in both cases, from 0.65 to 1.15 cm2 in case 1 and from 0.9 to 1.65 cm2 in case 2. Both patients required valve replacement during the follow-up, at 14 and 21 months. There was no restenosis, but echocardiography showed right atrial thrombosis in case 1. Progressive restenosis with peripheral edema and increase of the mean doppler gradient occurred in case 2. The procedure is feasible, safe, and well tolerated. It provides significant immediate hemodynamic improvement, but it should be considered as a palliative technique since a normal valve area can not usually be obtained and a restenosis is likely to occur at midterm follow-up.

Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

“…Long-term follow-up data, when available, did, however, identify cases of restenosis. 4,8 Wren and Hunter 4 observed an immediate gradient reduction and clinical improvement in their 19-year-old patient, but also reported restenosis at 3 months that necessitated repeat valvuloplasty. This was followed by recurrence of symptoms and stenosis at 6 months, at which point no further valvuloplasty was attempted.…”

“…Although objective data quantifying the symptoms is not available in many of the case reports, most patients were reported to have presented with severe dyspnea, orthopnea, and pedal edema before intervention and to have experienced postprocedural improvement in those symptoms. For some patients the good effects lasted as long as 16 months, 8 whereas in others those effects lasted only a few months, necessitating a repeat PTTBV procedure or TV replacement. The only unsuccessful procedure was the one in our 3rd patient.…”

“…Nine patients (47%) had single balloons, whereas 7 (37%) had double balloons. [6][7][8]10 In 2 cases (16%), sequential dilation with balloons of increasing sizes was performed. 11 Neither single-nor multiple-balloon techniques led to severe valvular regurgitation in the immediate postprocedural period.…”

Interventionelle Therapie bei Trikuspidalklappenerkrankungen

“…Diese führte in mehreren Studien zwar zur Reduktion des Gradienten, jedoch kam es überproportional zu hochgradigen Klappeninsuffizienzen. Langzeitergebnisse des Verfahrens liegen bisher nicht vor [41,43].…”

Management von Trikuspidalklappenerkrankungen

“…Diese führte in mehreren Studien zwar zur Reduktion des Gradienten, jedoch kam es überproportional zu hochgradigen Klappeninsuffizienzen. Langzeitergebnisse des Verfahrens liegen bisher nicht vor [26,35]. Bei einer Trikuspidalklappenendokarditis sind Herzgeräusche im Rahmen der klinischen Untersuchung fast nie auskultierbar [15].…”