Percutaneous tricuspid valve-In-ring replacement for the treatment of recurrent severe tricuspid regurgitation

Percutaneous tricuspid valve-in-ring replacement can be an alternative to surgery for high-risk patients with symptomatic severe tricuspid regurgitation that recurs after surgical ring repair. Practitioners must pay attention to the specific technical details associated with this procedure that include: using the ring as a fluoroscopic landmark, sizing the valve area with multi-modality imaging, choosing the appropriate device based on the patients anatomy, and dealing with the inevitable paravalvular leak (created by the ring deformation in the absence of valve-specific devices). Our case demonstrates that percutaneous tricuspid valve-in-ring replacement is a feasible treatment that can result in both hemodynamic and symptomatic improvement.