# First Reported Case of Simultaneous Transjugular Tricuspid Valve-in-Ring and Pulmonary Valve-in-Valve Implantation

## TL;DR

A 46-year-old man with repaired tetralogy of Fallot underwent a novel dual transjugular valve replacement to treat severe right heart failure.

## Contribution

This is the first reported case of simultaneous transjugular tricuspid valve-in-ring and pulmonary valve-in-valve implantation.

## Key findings

- Transjugular valve implantation resolved severe tricuspid and pulmonary dysfunction in a patient with complex anatomy.
- The procedure avoided high-risk surgery and transfemoral access due to anatomical constraints.
- Meticulous imaging and planning enabled successful dual valve replacement.

## Abstract

Patients with repaired tetralogy of Fallot often require reinterventions for right-sided valve dysfunction. Surgical reoperations carry high morbidity, making transcatheter valve-in-valve and valve-in-ring procedures valuable alternatives.

A 46-year-old man with repaired tetralogy of Fallot, prior tricuspid annuloplasty, pulmonary bioprosthesis, and transcatheter pacemaker presented with advanced right heart failure. Imaging showed massive right atrial enlargement, severe tricuspid stenosis/regurgitation, pulmonary dysfunction, and indwelling leads, precluding transfemoral access. Repeat surgery was prohibitive; thus, simultaneous transcatheter intervention was pursued. Via a transjugular approach, Edwards Sapien valves were implanted in both the tricuspid and pulmonary positions, with complete resolution of regurgitation.

This case illustrates the feasibility of dual transjugular right-sided valve replacement in complex congenital heart disease. Meticulous imaging and planning allowed safe navigation of anatomical challenges.

A combined transjugular-approach valve-in-ring and valve-in-valve procedure can provide an effective alternative when surgery is prohibitive.