Intracardiac echo guided valvuloplasty of a stenotic tricuspid prosthetic valve in a patient with idiopathic hypereosinophilic syndrome

Echocardiography
Darryl J BurstowDarren L Walters

Abstract

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.

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Citations

May 1, 2012·Current Infectious Disease Reports·John Francis Sedgwick, Darryl John Burstow
Mar 1, 2009·Journal of Cardiovascular Translational Research·Piers C A Barker
Jun 19, 2013·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Shelby KuttyDavid A Danford
Jan 9, 2014·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Gautam ReddyOluseun Alli
Dec 5, 2014·Journal of Cardiac Surgery·Josef BesikJan Pirk
Feb 26, 2013·Journal of the American College of Cardiology·Jayanthi N Koneru, Kenneth A Ellenbogen
Mar 8, 2017·Texas Heart Institute Journal·Gaurav RanaNikolaos Kakouros

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