Valve-in-valve transcatheter pulmonary valve replacement in carcinoid heart disease: a case report

Carcinoid heart disease (CHD) commonly affects right-sided heart valves, often leading to progressive right heart failure (RHF) and structural valve deterioration.

A 30-year-old male with CHD and prior bioprosthetic tricuspid and pulmonic valve replacements presented with New York Heart Association Class III symptoms and RHF. Imaging revealed significant degeneration of both valves. Given the high surgical risk (EuroSCORE II 9.12%), the Heart Team opted for transcatheter pulmonary valve replacement (TPVR). Despite challenging anatomy, a Melody valve (Medtronic) was successfully implanted, resulting in improved haemodynamics and no significant residual regurgitation.

Bioprosthetic failure in CHD poses significant treatment challenges. This case underscores the growing role of TPVR as a less invasive and effective alternative to surgery in high-risk patients, with advanced imaging playing a pivotal role in planning and execution.