https://orcid.org/0000-0002-9997-7465
A 65-year-old woman with carcinoid syndrome presented with worsening of right heart failure symptoms (New York Heart Association II/III). Echocardiographic examination revealed carcinoid induced torrential tricuspid regurgitation (TR). Given the prohibitive surgical risk and unfavourable anatomical conditions for orthotopic intervention, we successfully performed a transcatheter heterotopic bi-caval valve implantation with a TricValve® system (P+F Products + Features GmbH, Vienna, Austria). Immediately after the deployment, a large field-of-view intravascular ultrasound (IVUS; Philips North America Corporation, Andover, MA, USA) was used to measure the cross-sectional stent frames dimensions (Panel A) and to evaluate the prosthetic leaflets motion (see Supplementary data online, Videos S1 and S2). At 30 post-procedural day, computed tomography angiography (CTA; 384-row SOMATOM® Definition Flash, SIEMENS, Forchheim, Germany) confirmed compliance with peri-procedural IVUS assessment (Panels B and C). Interestingly, all CTA dimensions were higher suggesting the tendency of the stent frames for expansion in time. However, the diameter of the mid part of the superior vena cava prosthesis was substantially bigger (2-A vs. 2-B). This particular part called ‘belly’ is positioned at the confluence with brachiocephalic veins. Since this area is not laterally limited by the vascular walls, there is much more space for expansion. This case presents a unique clinical scenario of carcinoid-induced torrential TR highlighting the role of novel transcatheter diagnostic and treatment methods. We showed for the first time that the peri-procedural IVUS assessment during bi-caval valve implantation correlates with post-procedural CTA measurements. Moreover, the online perspective offered by IVUS might be helpful in assessing the functional performance of newly implanted valves.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
Funding: None declared.
Data availability: The data underlying this article are available in the article and in its online supplementary material.
Author notes
Conflict of interest: None declared.
