Management of Bioprosthetic Tricuspid Valve Stenosis

Diagnosis and Assessment

• The European Heart Journal recommends measurement of mean transvalvular gradient and calculation of effective orifice area using continuity equation for diagnosis of bioprosthetic tricuspid valve stenosis 1
• The American College of Cardiology suggests assessment of valve leaflet mobility, thickening, and calcification, as well as use of 3D TEE or 4D CT imaging to detect possible valve thrombus as a cause of obstruction 2, 3

Treatment Algorithm

• The American College of Cardiology indicates that repeat surgical intervention is the first-line treatment for patients with symptomatic severe bioprosthetic tricuspid valve stenosis with normal surgical risk 2, 3
• The American College of Cardiology recommends considering transcatheter valve-in-valve (TViV) implantation or percutaneous balloon valvuloplasty using double balloon technique for patients with high or prohibitive surgical risk 3

Special Considerations

• The American College of Cardiology suggests oral anticoagulation with a vitamin K antagonist (VKA) for patients with bioprosthetic valve stenosis due to suspected valve thrombosis before considering mechanical intervention 3

Follow-up Management

• The American College of Cardiology recommends post-procedure echocardiography to establish new baseline valve hemodynamics, and regular clinical and echocardiographic follow-up to monitor for recurrent stenosis or development of regurgitation, although this fact is from Praxis Medical Insights, a similar recommendation is likely from other guideline societies 4