A sixty year-old-woman was submitted to replacement of tricuspid valve 24 years ago, due to infective endocarditis in a previous normal heart. During active endocarditis she had rupture of cuspide with severe tricuspide regurgitation and right cardiac failure. After surgery she had a good evolution and long-term follow up. At now she shows important stenosis, without calcification or regurgitation, but shows hepatomegaly and inferior limbs edema despite of drugs therapy.
Yesterday I made the balloon dilation of this patient, using a Inoue catheter o 30 mm of diameter. The gradient decrease of 10 mmHg to 3 mmHg. The diastolic murmur disappear and the flow across the tricuspid valve is normal by ecoddoplercardiogram. There is no tricuspid regurgitation. A new ecodoppler will be performed in 30 days.
Dear,
The short term result is very satisfying and the absence of calcification gives hope that this hemodynamic result will remain on mid and long-term. A thorough echocardiographic follow-up is mandatory, since not so much is known about dilatation in this position.
Thank's a lot for your answer!Now i try to convince my cath-lab collegues!
Balloon dilatation in the right side in a patient in already severe right sided failure and I suspect a pulsatilla liver - not a good idea
Dear Dr. Elias. If the severe right sided failure is due to chronic tricuspid regurgitation, severe dysfunction of right ventricle is present, but in tricuspid stenosis in sinus rhythm the right ventricular function is normal and balloon dilation can be a good idea.
Yes Jose you are correct,I think you are probably delaying the inevitable,anyway will be interesting to see how long this lasts,if so would be great,regards
Dear Elias, the mitral valvoplasty also is a form to delay the surgery. The valve replacement is palliative and reoperation is the routine. The coronary stent implantation is palliative, the coronary bypass surgery is palliative. Second valve replacement in my pacient is not a cure, but a paliative treatment. I wait exactly delay a reoperation.
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