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Migration Of An Evoque Tricuspid Valve Following Transcatheter Tricuspid Valve Replacement
Mohamed Hassan.
University Hospital of Wuerzburg, würzburg, Germany.
Background: Transcatheter tricuspid valve replacement (TTVR) using the Evoque valve is a novel therapeutic option for patients with severe tricuspid regurgitation, particularly for those at high surgical risk. While the procedure has shown promising outcomes, complications such as valve dislocation or embolization can pose significant challenges, often necessitating urgent surgical intervention. This case illustrates the clinical course of a patient who developed valve migration into the right ventricular outflow tract (RVOT) following TTVR, emphasizing the importance of accurate valve positioning. Methods: A patient with severe symptomatic tricuspid regurgitation underwent TTVR with an Evoque valve. The valve was deployed under fluoroscopic guidance, and its position was initially deemed satisfactory with slight tilting. Shortly after the procedure, the patient exhibited frequent ventricular extrasystoles and signs of hemodynamic instability. Urgent computed tomography (CT) imaging revealed migration of the Evoque valve into the RVOT. The migration caused severe mechanical damage to the chordae tendineae of the native tricuspid valve, leading to further destabilization of valve function.Given the life-threatening nature of the complication, the patient was taken to the operating room for emergent surgical intervention. The Evoque valve was carefully retrieved, and a surgical bioprosthetic tricuspid valve replacement was performed. Additionally, damaged native valve structures were removed, and the right atrioventricular outflow tract was reconstructed. Results: The surgery was successful, with no intraoperative complications. Postoperatively, the patient demonstrated stable hemodynamics. Transthoracic echocardiography confirmed proper function of the newly implanted surgical bioprosthetic valve, with no signs of residual regurgitation or obstruction. The patient experienced an uneventful recovery and was discharged in stable condition. Conclusion: This case highlights the critical importance of optimal positioning during TTVR with the Evoque valve. Migration or dislocation of the valve can lead to devastating complications, including damage to the native valve apparatus and hemodynamic instability. Accurate positioning during deployment is essential to avoid these complications, and close post-procedural monitoring is necessary to detect early signs of valve dislocation. Surgical backup should be available in centers performing TTVR to manage emergencies effectively. This case reinforces the need for meticulous procedural planning and precise valve deployment to ensure postoperative stability and favorable outcomes.
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