http://dx.doi.org/10.14503/THIJ-15-5408 43 Texas Heart Institute Journal • Feb. 2017, Vol. 44, No. 1 © 2017 by the Texas Heart ® Institute, Houston Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis Percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV) is an accepted treat- ment option for symptomatic severe native tricuspid valve stenosis, although surgical tri- cuspid valve replacement remains the treatment of choice. There have been few reports of successful PTTBV for bioprosthetic tricuspid valve stenosis. We present case reports of 3 patients from our hospital experience. Two of the 3 cases were successful, with lasting clinical improvement, whereas the 3rd patient failed to show a reduction in valve gradient. We describe the standard technique used for PTTBV. We present results from a literature review that identified 16 previously reported cases of PTTBV for bioprosthetic severe tricus- pid stenosis, with overall favorable results. We conclude that PTTBV should perhaps be considered for a select patient population in which symptomatic improvement and hemo- dynamic stability are desired immediately, and particularly for patients who are inoperable or at high surgical risk. (Tex Heart Inst J 2017;44(1):43-9) S evere tricuspid valve stenosis (TS) is associated with a mean gradient across the tricuspid valve (TV) of at least 5 mmHg, a calculated TV area of less than 1 cm 2 , or both. 1 Patients with TS usually present with low-cardiac-output state, syncope or presyncope, and signs consequent to elevated right atrial pressures, such as hepatomegaly, anasarca, lower-extremity edema, and ascites. In a patient with symptomatic TS, intervention should be considered: the American College of Cardiol- ogy/American Heart Association 2014 valvular heart disease guidelines give surgical replacement a class I recommendation for both tricuspid bioprosthetic and native- valve stenosis. Percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV) can be considered in patients with severe, symptomatic, native TS without tricuspid regurgitation (TR), as a class IIb guideline indication. 1 It is less preferable than surgery, because most cases of severe TS have concurrent TR that might worsen after balloon dilation. In addition, there are insuff icient data on the long-term outcomes of patients undergoing PTTBV. Data on PTTBV in patients with bioprosthetic TS are more limited still, consisting of isolated case reports. Nonetheless, bioprosthetic PTTBV can be an appropriate consideration for patients who are not surgical candidates or are at high risk of surgery because of comorbidities, and who have mild TR. We present herein case reports of 3 patients, as well as a comprehensive compilation and review of previous cases from the literature. Case Reports Patient 1 A 47-year-old man presented with symptoms of exertional presyncope and right-sided heart failure. His history was significant for severe familial cardiomyopathy, for which he had undergone orthotopic heart transplantation at the age of 34 years. 2 The patient had then developed severe TR, attributed to valve damage by multiple endomyocar- dial biopsies, and at age 38 had undergone TV replacement with use of a Carpentier- Edwards bioprosthesis (Edwards Lifesciences LLC; Irvine, Calif ). The patient remained asymptomatic until his current presentation. Transthoracic echocardiography revealed TS with a mean transvalvular gradient of 10 mmHg. The patient refused surgical TV replacement, and was considered at increased risk because Case Reports Gaurav Rana, MBBS Rohit Malhotra, MBBS Anjali Sharma, MBBS Nikolaos Kakouros, MBBS, PhD Key words: Balloon valvu- loplasty/methods; cardiac catheterization; dilation/ methods; heart valve prosthesis implantation; hemodynamics/physiology; treatment outcome; tricus- pid valve stenosis/complica- tions/diagnostic imaging/ physiopathology/therapy From: Divisions of Cardiovascular Medicine (Drs. Kakouros and Rana) and Internal Medicine (Drs. Malhotra and Sharma), UMass Memorial Medical Center, University of Massachusetts, Worcester, Massachusetts 01605 Address for reprints: Gaurav Rana, MBBS, Division of Cardiovascular Medicine, Wellmont CVA Heart Institute, 2050 Meadowview Pkway., Kingsport, TN 37660 E-mail: drgauravrana@gmail.com