Transcatheter Valve-In-Valve Implantation in Patients With Fluoroscopically Invisible Tricuspid Valve Prostheses

Tricuspid bioprostheses are prone to structural valve degeneration, often requiring complex interventions. Surgical reoperation carries high morbidity and mortality, whereas transcatheter valve-in-valve implantation offers a safer alternative. However, when the tricuspid prosthesis is fluoroscopically invisible, accurate valve positioning becomes challenging. This case series presents 3 such patients successfully treated using a novel adjunctive technique. A coronary guidewire was positioned in the right coronary artery as an anatomical marker for the atrioventricular groove. Balloon pre-dilatation was then performed to delineate the bioprosthetic valve's position, guiding precise deployment of the new valve. All procedures utilized Myval prostheses and were completed without major complications. Post-procedural echocardiography confirmed optimal valve function, low transvalvular gradients, and no residual regurgitation. This reproducible approach of combining RCA guidewire marking with balloon pre-dilatation offers an accurate, low-risk solution for managing fluoroscopically invisible tricuspid prostheses during valve-in-valve implantation.