Transcatheter Valve-in-Valve and Iatrogenic ASD Closure for Tricuspid Thrombosis in Heparin-Induced Thrombocytopenia

BACKGROUND: Early bioprosthetic valve thrombosis is a life-threatening complication, and hypercoagulable states such as heparin-induced thrombocytopenia (HIT) can contribute to the formation of thrombi. CASE SUMMARY: A 67-year-old woman with a prior history of HIT and surgical replacement of mitral and tricuspid valves presented with shortness of breath. Transthoracic echocardiography showed an atrial septal defect with right-to-left shunt and thickened tricuspid valve leaflets. Intraoperative transesophageal echocardiography revealed a severe thrombotic bioprosthetic tricuspid valve. She underwent successful transcatheter tricuspid valve-in-valve (TTViV) and atrial septic device closure. DISCUSSION: TTViV is a critical option for patients presenting with early tricuspid valve thrombosis due to HIT. Increased right atrial pressure from tricuspid thrombosis can result in dehiscence of the interatrial sutures, leading to a hemodynamically significant shunt and necessitating its closure. TAKE-HOME MESSAGES: HIT is a prothrombotic state that can lead to early valve thrombosis. TTViV offers an effective treatment option for high-surgical risk patients.