Successful balloon valvotomy in isolated congenital tricuspid stenosis

Balloon dilatation of isolated severe tricuspid valve stenosis

Tricuspid valve stenosis is mostly rheumatic in origin. It almost always occurs in association with mitral valve disease. There are only few case reports of isolated tricuspid valve stenosis. We report a case of isolated tricuspid valve stenosis, which was treated with balloon dilatation.

Percutaneous transvenous tricuspid commissurotomy in a patient with congenitally corrected transposition of great arteries: a case report

Percutaneous balloon tricuspid valvotomy was successfully performed in a 45-year-old female with congenitally corrected transposition of great arteries with severe rheumatic left atrioventricular (tricuspid) valve stenosis. Technical modifications in the standard procedure were made keeping in mind the left-handed ventricular loop, left and anterior aorta, wedged pulmonary valve between the interatrial septum and the mitral valve with deviation of the atrial septum away from the ventricular septum, side-by-side positioned ventricles with an added superoinferior obliquity produced by excessive tilting, and an abnormal orientation of ventricular mass in relation to the thorax, with the apex pointing slightly rightwards. A final valve area of 1.4 cm(2) and a fall in the peak/mean left atrial pressures from 37/32 mm Hg to 13/10 mm Hg were achieved without complications. This case of percutaneous transvenous commissurotomy is unique in view of the rarity of the combination of this congenital heart disease and rheumatic heart disease and successful commissurotomy in such an unusual cardiac anatomy using the Inoue technique.

Balloon valvuloplasty for palliative treatment of tricuspid stenosis with right-to-left atrial-level shunting in a dog

A 3.75-year-old castrated male Chesapeake Bay Retriever was referred for evaluation of tachypnea, exercise intolerance, and cyanosis. Echocardiographically, there was severe tricuspid stenosis and right-to-left atrial-level shunting of blood. Marked compensatory polycythemia had developed; the PCV was 75%. Balloon dilation of the tricuspid stenosis was performed. Subsequent echocardiographic examinations demonstrated a reduction in the pressure gradient across the tricuspid valve. The PCV returned to the reference range, and the dog's clinical status improved during the 12 months after the procedure. Tricuspid stenosis is an uncommon lesion in dogs and, in the dog of this report, was assumed to have resulted from tricuspid dysplasia. Cyanosis was a result of right-to-left shunting of blood. Limited treatment is available for dogs with cyanotic heart disease. In this dog, balloon dilation of the stenotic tricuspid valve was palliative.

The Inoue balloon for dilatation of the tricuspid valve: a modified over-the-wire approach

The Inoue balloon was used for dilatation of tricuspid stenosis in a 74 year old woman. The valve was reached by an over-the-wire approach with a 0.025 exchange length guide wire. The Inoue stylet would not reach the tricuspid orifice because the right atrium was so large. The Inoue balloon's special dilatation characteristics allowed good positioning at the tricuspid orifice. After dilatation to 27.5 mm, the pressure drop across the valve was reduced from 12 to 5 mm Hg. Further dilatation at 30 mm, however, created moderately severe tricuspid reflux without a further reduction of gradient. The Inoue balloon is suitable for dilatation of tricuspid stenosis but small increments in dilatation size may be required for optimal reduction in gradient without creating significant reflux.