Balloon Abrasion Valvuloplasty Of Stenotic Tricuspid Valve Bioprosthesis
Michael DeFrain, MD, Brian Hummel, Paul DiGiorgi, Randall Buss.
Lee Health, Health Park Medical Center, Ft. Myers, FL, USA.
OBJECTIVE: A 25 year old female intravenous drug user presents with MSSA sepsis. She underwent tricuspid valve replacement 5 months earlier at an outside institution for tricuspid valve infective endocarditis. Following discharge, the patient resumed her prior habit of intravenous heroin injection. Transthoracic echocardiogram demonstrates thickened debris on the bioprosthetic leaflets producing restriction and stenosis. Right heart failure signs began to develop despite optimal medical therapy.
METHODS: A 20mm flow through balloon was placed within the tricuspid bioprosthesis and agitated while the balloon was fully inflated. This was done with the intent of removing debris from the leaflets in order to improve leaflet mobility and decrease the rigidity of the leaflets contributing to tricuspid stenosis.
RESULTS: Peak and mean pressure gradients were measured echocardiographically before and after abrasion valvuloplasty, and were: 26 and 16, and 12 and 8, respectively. Cardiac index increased to 5l/min/m2 from 3l/min/m2 following the procedure. SaO2 remained unchanged before and after the procedure.
CONCLUSIONS: Prosthetic abrasion valvuloplasty is a modality that enables the release of infection-related fibrotic material that can improve the hemodynamic performance of tricuspid valve bioprosthetics and consequently mitigate the clinical stigmata of right heart failure in appropriately selected patients.
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