Related Experiment Video
Updated: May 9, 2026

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?
Scott M Lilly1, Jack Rome, Saif Anwaruddin
1Division of Cardiovascular Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
Background:
A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.
Investigation:
Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography.
Diagnosis:
She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure.
Treatment:
A transcatheter 26 mm Edwards SAPIEN valve was placed in the tricuspid position, resulting in near normalisation of tricuspid valve gradient. This represents the first report of a combined valve-in-ring (VIR) and valve in a homograft valve (VIV) SAPIEN implantation.
Related Concept Videos
Mitral Stenosis III: Medical Management
Mitral Stenosis IV: Nursing Management
Aortic Regurgitation III: Medical Management
Mitral Regurgitation III: Medical Management
Mitral Valve Prolapse II: Assessment and Management
Mitral Valve Prolapse III: Nursing Management

