Case report of a transcatheter pulmonic valve-in-valve replacement through a bioprosthetic tricuspid valve in a patient with carcinoid heart disease

Background Carcinoid heart disease (CHD) is a paraneoplastic syndrome that occurs in patients with metastatic neuroendocrine tumors (NET), often resulting in right sided valvular dysfunction and heart failure. Surgical valve replacement is the main treatment for CHD with valvular involvement, though many patients will eventually develop prosthetic valve degeneration. Case Summary We present a case of a 70 year-old female with metastatic NET, complicated by CHD status post surgical tricuspid and pulmonary valve replacement who presented with dyspnea. She was found to have worsening right sided heart failure in the setting of severe bioprosthetic pulmonic valve regurgitation (PR). Given the patient’s metastatic NET, prior sternotomy, and overall frailty, it was felt that surgical valve replacement would portend prohibitively high risks. In turn, the patient underwent transcatheter pulmonic valve-in-valve replacement via a bioprosthetic tricuspid valve. Post-deployment transesophageal echocardiography showed good pulmonic valvular function with no paravalvular leak, reduction of PR to mild, and reduction in the mean gradient from 15 mmHg to 4 mmHg. There was no evidence of damage to the bioprosthetic tricuspid valve. Conclusion This case demonstrates the feasibility, safety, and short term efficacy of bioprosthetic valve-in-valve interventions in patients with CHD with bioprosthetic valve degeneration.