Cracking a tricuspid perimount bioprosthesis to optimize a second transcatheter sapien valve‐in‐valve placement

Bioprosthetic valves degenerate over time. Transcatheter valve‐in‐valve procedures have become an attractive alternative to surgery. However, every valve increasingly diminishes the diameter of the valvar orifice. We report a 12‐year‐old female who had a previous transcatheter tricuspid valve‐in‐valve procedure; cracking the ring of a Carpentier Edwards Perimount valve by means of an ultrahigh pressure balloon allowed implantation of a further larger percutaneous valve. The advantage of this novel approach permits enlarging the inner valve diameter and may facilitate future interventions and prolong time to surgery. © 2016 Wiley Periodicals, Inc.