Transcatheter pulmonary and tricuspid valve-in-valve replacement for bioprosthesis degeneration in carcinoid heart disease

A 65-year-old lady presented with worsening peripheral oedema and functional limitation secondary to degeneration of St Jude Epic 21 mm pulmonary and St Jude Epic 27 mm tricuspid valves surgically implanted 4 years previously for carcinoid heart disease. She had maintained NYHA Class I functional capacity until 6 months previously but was now dyspnoeic after walking 100 yards. Echocardiography demonstrated severe pulmonary regurgitation and stenosis, severe tricuspid regurgitation and stenosis, and right ventricular impairment. Repeat surgery was considered too high risk, and concomitant transcatheter pulmonary and tricuspid valve-in-valve implantation was planned. Under general anaesthesia and intravenous octeotride cover, the right femoral vein was catheterized and …