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IVC Tric Valve Regurgitation Treatment With Ballooning Expanding the Valve After Downsizing With a Nonpremounted
Abdulaziz R Algethami1, Mohammad S Alotaibi2, Mohammed Almoaiqel2
1King Abdulaziz Cardiac Center, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Objective:
To assess the feasibility and effectiveness of valve-in-valve caval implantation using a balloon-expandable valve after AndraStent prestenting for bioprosthetic dysfunction in challenging venous anatomy.
Key Steps:
Computed tomography showed a 34-mm inferior vena cava (IVC), exceeding available balloon-expandable valve sizes. A 39-mm Andra XXL stent was used for IVC downsizing, enabling successful implantation of a 30-mm balloon-expandable valve, with postprocedural transesophageal echocardiography confirming optimal positioning and no regurgitation.
Potential Pitfalls:
Valve-in-valve caval implantation after prior caval valve implantation is technically challenging. Accurate imaging and sizing are critical to avoid malapposition, migration, or caval injury. Landing-zone selection must preserve hepatic venous inflow. Controlled Andra XXL expansion with fluoroscopy and transesophageal echocardiography optimizes alignment, while vigilant anticoagulation and follow-up mitigate thrombosis risk.
Take-Home Messages:
Comprehensive multimodality imaging is critical to identify prosthetic dysfunction and guide safe reintervention after prior caval valve implantation. Stent-assisted IVC downsizing can enable successful valve-in-valve caval implantation, with durable outcomes dependent on accurate sizing and precise deployment.
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