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. 2021 Jan 5;5(2):ytaa537.
doi: 10.1093/ehjcr/ytaa537. eCollection 2021 Feb.

Bloody tricuspid stenosis: case report of an uncommon cause of haemoptysis

Filippo Trombara  1   2 , Marco Bergonti  1   2 , Olga Toscano  1   2 , Alessia Dalla Cia  1 , Emilio M Assanelli  1 , Gianluca Polvani  1   2 , Antonio L Bartorelli  1   2
Affiliations

Bloody tricuspid stenosis: case report of an uncommon cause of haemoptysis

Filippo Trombara et al. Eur Heart J Case Rep. .

Abstract

Background: Haemoptysis is usually caused by pulmonary and infectious diseases. In few cases, it has a cardiac cause, such as pulmonary embolism or mitral valve stenosis. Haemoptysis may be an uncommon symptom of prosthetic valve dysfunction, being related to elevated right heart pressures.

Case summary: A 22-year-old woman from sub-Saharan Africa known for a triple valve replacement was hospitalized for dyspnoea and haemoptysis. A careful clinical evaluation excluded the most common causes of haemoptysis. Transthoracic echocardiogram showed normal biventricular function, normally functioning mechanical prosthetic aortic and mitral valves, and the biological tricuspid prosthesis showed an increased transvalvular gradient. Contrast chest computed tomography scan excluded pulmonary embolism and mechanical valve obstruction, but revealed marked systemic venous hypertension. Right heart catheterization confirmed increased right heart pressures and severe bioprosthetic tricuspid valve stenosis. The patient underwent a successful percutaneous tricuspid valve-in-valve replacement, with complete resolution of symptoms.

Discussion: The increase in venous pressures due to bioprosthetic tricuspid stenosis caused veno-venous shunts: blood from the lower body was drained into the superior vena cava via the azygos vein. Increased pressure in the latter affected pressure in bronchial veins and arteries, leading to haemoptysis. Cardiac surgical reinterventions are associated with worse outcomes and higher mortality rates. Management of a degenerated prosthetic tricuspid valve is challenging and requires a multidisciplinary assessment. Transcatheter tricuspid valve replacement is becoming a feasible option in patients with prosthetic dysfunction. Based on evidence to date, tricuspid valve-in-valve replacement appears to be a safe, feasible, and effective alternative in selected young patients.

Keywords: Case report; Haemoptysis; Prosthetic valve; Transcatheter valve replacement; Tricuspid valve stenosis; Venous hypertension.

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Figures

Figure 1
Figure 1
(A) Doppler appearance of stenosis jet on echocardiogram. LV, left ventricle; RA, right atrium; RV, right ventricle; TPV, tricuspid prosthetic valve. (B) Transtricuspid pressure gradients derived using the Bernoulli equation: peak maximum velocity 223 cm/s; mean gradient 13 mmHg.
Figure 2
Figure 2
(A) Coronary sinus (CS) dilation on contrast computed tomography scan. (B) Suprahepatic veins dilation on echocardiogram (SV).
Figure 3
Figure 3
Right heart catheterization. (A) Right atrium pressure curves (mean pressure 23 mmHg). (B) Right ventricle pressure curves (systolic/diastolic/mean pressures: 37/7/11 mmHg).
Figure 4
Figure 4
(A) Fluoroscopic image after the tricuspid valve-in-valve replacement (VIV). (B) Post-procedural echocardiogram with a significant decrease in pressure gradients, with a peak maximum velocity of 129 cm/s and a mean gradient of 4 mmHg.
None
See this image and copyright information in PMC

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