Transcatheter Double Valve Replacement to Treat Aortic Stenosis and Severe Tricuspid Regurgitation with 3D Printing Guidance after Mechanical Mitral Valve Replacement

Figures

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  Figure 1. The Lux-Valve is a self-expanding valve. The stent is made of a nickel–titanium alloy, and the biological leaflet is bovine pericardium. The prosthesis is implanted via the right atrial approach and firmly fixed in the tricuspid annulus with its unique anchor device. The large annulus of the prosthesis is located in the right atrium, which also prevents paravalvular leakage. The sheath is 32 Fr, with an adjustable bending function. (a) The delivery system of the Lux-Valve; (b) right atrial view of the Lux-Valve; (c) the loading system of the Lux-Valve.

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  Figure 2. Images before transcatheter tricuspid valve replacement. (a) Digital subtraction angiography image before transcatheter aortic valve replacement (TAVR) in 2021; the arrow indicates the patient’s aortic stenosis. (b) Three-dimensional reconstruction before TAVR; the arrow points to the patient’s aortic stenosis. (c) Digital subtraction angiography shows that the aortic valve stent is fixed securely in place; the arrow points to the stent. (d) Three-dimensional reconstruction after TAVR; the arrow points to the stent. (e) The yellow arrow points to the massive regurgitation in TV. Chinese words in Figure 2e are temperature. (f) The assessment of the computed tomography angiography images before TTVR. RA: right atrium; RV: right ventricle.

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  Figure 3. The 3-dimensional (3D)-printed model reconstructed by computed tomography angiography for preprocedural planning and simulation. (a) Three-dimensional reconstruction image from the lateral view. (b) Three-dimensional reconstruction image from the right atrial (RA) view. (c) Three-dimensional reconstruction image from the right ventricular (RV) view. (d) The 3D-printed model from the lateral view. (e) The model from RA view. (f) The model from the RV view. CTA: computed tomography angiography; RA: right atrial; RV: right ventricle; RVOT: right ventricular outflow tract.

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  Figure 4. Intra- and postprocedural digital subtraction angiography and transesophageal echocardiography images showing the procedures. (a) Computed tomography angiography before the procedure showed massive regurgitation in the tricuspid valve; the arrow indicates the regurgitation. (b) The right atrium was incised and the delivery system was delivered into the right ventricle; the arrow points to the delivery system. (c) The anchor pin was positioned in the septum; the arrow points to the anchor pin. (d) The delivery system was separated from the tricuspid valve and withdrawn from the right atrium; the arrow points to the delivery system. (e) Computed tomography angiography shows no significant regurgitation; the arrow points to the tricuspid valve. (f) Transesophageal echocardiography displayed only mild TR; the arrow indicates the TR. Chinese words are temperature. RA: right atrium; RV: right ventricle.

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  Figure 5. The 3-dimensional (3D)-printed model after the procedure verified the position of the stented valve. In the 3D reconstruction images, the right atrium and right ventricle are blue; the left atrium and the left ventricle are red; the mechanical mitral valve is yellow; the aortic valve stent is green; and the LuX-Valve stent is purple. However, in the 3D-printed model, the mechanical mitral valve is black, the aortic valve stent is red, and the LuX-Valve stent is blue. (a) Three-dimensional reconstruction image from the right atrial view; (b) 3D reconstruction image from the lateral view; (c) 3D reconstruction image from the right ventricular view; (d) the 3D-printed model from right atrial view; (e) the model from the lateral view; (f) the model from right ventricular view.