Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high-surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis “ring.” Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro-aortic distance. Performing a second major procedure, such as tricuspid valve-in-valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83-year-old woman with rheumatic heart disease, with previous implantation of a Bjork–Shiley monoleaflet mitral prosthesis, and Carpentier-Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease.

中文翻译：

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二尖瓣机械假体患者的经导管主动脉瓣和三尖瓣瓣膜联合植入术

尽管风湿性心脏病在西方国家逐渐不常见，但它仍然是全球的一个重大负担。对于老年或高手术风险的患者，多瓣膜疾病可能需要复杂的经皮入路。由于主动脉瓣和刚性二尖瓣机械假体“环”之间的干扰，对先前使用单叶二尖瓣假体的患者进行经导管主动脉瓣植入（TAVI）具有挑战性。先前的病例报告称，在二尖瓣-主动脉距离足够的患者中使用了 CoreValve 或 Edwards Sapien 主动脉瓣。在单次经皮介入治疗期间依次进行第二次主要手术，例如三尖瓣中瓣术 (TVIV)，会增加治疗的复杂性。一名患有风湿性心脏病的 83 岁女性，曾植入 Bjork-Shiley 单叶二尖瓣假体和 Carpentier-Edwards 29 三尖瓣生物假体，因严重主动脉狭窄和三尖瓣生物假体狭窄而出现失代偿性心力衰竭。经过 HeartTeam 讨论，由于手术风险过高，该患者被认为无法手术。作为替代方案，我们讨论并提出了 TAVI (Navitor FlexNav) 和经导管 TVIV 替代品 (Edwards Sapiens 3 Ultra)，这两种技术在单个手术中顺序执行。对于既往接受过单叶二尖瓣机械假体的患者进行 TAVI 治疗，对于患有多瓣膜疾病且无法手术的患者进行 TVIV 治疗可能是一种可行的方法。