# Case report of a transcatheter pulmonic valve-in-valve replacement through a bioprosthetic tricuspid valve in a patient with carcinoid heart disease

## TL;DR

A 70-year-old woman with carcinoid heart disease underwent a transcatheter pulmonic valve replacement through a bioprosthetic tricuspid valve, showing the procedure's feasibility and safety.

## Contribution

Demonstrates the feasibility and safety of transcatheter valve-in-valve replacement in carcinoid heart disease patients with bioprosthetic valve degeneration.

## Key findings

- Transcatheter pulmonic valve-in-valve replacement was successfully performed in a patient with carcinoid heart disease.
- Post-deployment echocardiography showed improved pulmonic valve function with no paravalvular leak.
- The procedure resulted in reduced right-sided heart failure symptoms and no damage to the bioprosthetic tricuspid valve.

## Abstract

Carcinoid heart disease (CHD) is a paraneoplastic syndrome that occurs in patients with metastatic neuroendocrine tumours (NETs), often resulting in right-sided valvular dysfunction and heart failure. Surgical valve replacement is the main treatment for CHD with valvular involvement, though many patients will eventually develop prosthetic valve degeneration.

We present a case of a 70-year-old female with metastatic NET, complicated by CHD status post-surgical tricuspid and pulmonary valve replacement who presented with dyspnoea. She was found to have worsening right-sided heart failure in the setting of severe bioprosthetic pulmonic valve regurgitation. Given the patient’s metastatic NET, prior sternotomy, and overall frailty, it was felt that surgical valve replacement would portend prohibitively high risks. In turn, the patient underwent transcatheter pulmonic valve-in-valve replacement via a bioprosthetic tricuspid valve. Post-deployment trans-oesophageal echocardiography showed good pulmonic valvular function with no paravalvular leak, reduction of PR to mild, and reduction in the mean gradient from 15 to 4 mmHg. There was no evidence of damage to the bioprosthetic tricuspid valve.

This case demonstrates the feasibility, safety, and short-term efficacy of bioprosthetic valve-in-valve interventions in patients with CHD with bioprosthetic valve degeneration.