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Intracardiac Echo Guided Valvuloplasty of a Stenotic Tricuspid Prosthetic Valve in a Patient with Idiopathic Hypereosinophilic Syndrome
Author(s) -
Burstow Darryl J.,
West Malcolm L.,
Walters Darren L.
Publication year - 2006
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2006.00214.x
Subject(s) - medicine , tricuspid stenosis , cardiology , tricuspid valve , regurgitation (circulation) , atrioventricular valve , stenosis , intracardiac injection , radiology , surgery , ventricle
A 52‐year‐old male with idiopathic hypereosinophilic syndrome (HES) was transferred to our institution following the development of acute respiratory failure and shock. He had previously undergone tricuspid valve replacement with bioprosthetic valves on two occasions: the initial surgery for severe native tricuspid valve stenosis and the redo surgery for severe prosthetic valve stenosis and regurgitation. Conventional imaging assessment using transoesophageal echocardiography was suboptimal and comprehensive assessment of prosthetic valve function was aided by the use of intracardiac echocardiography (ICE). ICE provided high quality 2D imaging of the prosthesis demonstrating thrombus‐like material coating the inner surfaces of the prosthetic valve stents effectively forming a tunnel‐like obstruction. Unusual hemodynamics secondary to severe tricuspid stenosis were demonstrated by CW Doppler with intermittent “signal fusion” resulting from blunted respiratory variation in the markedly elevated right atrial pressure relative to right ventricular pressure. Successful balloon valvuloplasty was performed with ICE proving highly valuable in guiding balloon position as well as monitoring the efficacy of the subsequent inflations.