CASE & Plan:
42-year-old female presents with progressive dyspnea NYHA class III and increased ascites despite maximal medical therapy over the past 7 months. Past medical history is significant for RHD s/p mechanical MVR in 1998 (age of 17), constrictive pericarditis with severe TR s/p pericardiectomy, right atrial patch plasty, and surgical TVR with a 27mm Epic Porcine valve in 2021, SSS s/p leadless PPM, AF, and cirrhosis with esophageal varices. TEE showed preserved LVEF, severe bi-atrial enlargement, severe bioprosthetic tricuspid valve stenosis, and regurgitation (mean TV gradient 10 mmHg, PHT 331 msec at 78 bpm) from malcoaptation of TV leaflets secondary to severe pannus overgrowth within the surgical valve. The heart team found the patient at high risk for redo surgical TVR and recommended VIV TTVR. Now planned for VIV TTVR via percutaneous femoral venous access using a 26mm Sapien-3 Ultra valve under GA.