like off


Ramdas Nayak H


Ramdas Nayak H1


Rajagiri Hospital, India1
Valve - Mitral & Tricuspid Valve

Bicaval Valve Implantation

Ramdas Nayak H1

Rajagiri Hospital, India1

Clinical Information

Patient initials or Identifier Number


Relevant Clinical History and Physical Exam

       -Severe organic TR with moderate RV dysfunction (TAPSE 1.1cm)(No evidence of RVEMF, gigantic RA and hugely dilated IVC non collapsing). -Atrial fibrillation with controlled ventricular rate-Anemia-Hypochromic microcytic with iron deficiency, Blood loss due to haemoptysis and Haematemesis-Hypothyroidism-Chronic kidney disease- Stage 3 B (eGFR- 39 ml/min/1.73m2)Pallor, Raised JVP, hepatomegaly, Bilateral pedal edema, Irregularly irregular Pulse, Varing S1,  S2 Normal, Pansystolic Murmur
PRE 2.avi
PRE 3.avi

Relevant Test Results Prior to Catheterization

Relevant Catheterization Findings

Interventional Management

Procedural Step

-TEE image was obtained with best visualisation of both SVC and IVC (Caval view)-Femoral vein Approach. -Pigtail Catheter in Right Pulmonary artery, as a marker for placement of SVC valve.-SVC Angio to delineate the anatomy(Innominate vien) for placement of SVC valve. -Terumo wire encircling the roof of RA for double check of the landing zone of the distal part of SVC valve. SVC valve was introduced after cut down of femoral vein and placed in SVC after all parameters of exact placement including venogram from right brachial vein SVC valve was released. -Hepatic Vein Angiogram for placement of IVC Valve where in the valve is placed just above the hepatic vein so as to prevent obstruction of hepatic flow. 

Pigtail catheter 1.mp4
SVC Angio 2.mp4
Terumo Wire 3.mp4
SVC Valve 4.mp4
SVC Valve 5.mp4
hepatic Valve Angio 6.mp4
IVC Valve 7 .mp4
Final 8.mp4
TEE 9.mp4

Case Summary

- Isolated tricuspid valve disease is a rear entity, usually occurs along with left sided valve disease. surgery for isolated right sided valve carries high morbidity and mortality
- Percutaneous procedure to improve symptom status and quality of life has been performed with success, however long-term results have to be validated. 
- In our patient, the most challenging was pre and post procedural management in view of multiple co-morbidities.
- At one-year follow-up patient has improved symptomatically and living better quality of life. 

AP VALVES & SH 2021 Virtual Aug 05, 2021
What neat work! This shows a resounding result!