Simultaneous Transcatheter Replacement of Four Cardiac Valves in a 58-year-old Female

Sep 30, 2026

A 58-year-old woman with rheumatic heart disease and prior triple bioprosthetic valve replacement presented with progressive dyspnea, chest tightness, and palpitations. Years after surgery, she developed NYHA III heart failure, irregular rhythm, and advanced degeneration with severe stenosis and regurgitation across all prostheses, pulmonary valve regurgitation, a large right atrial thrombus, biatrial enlargement, and biventricular dysfunction. A fully percutaneous simultaneous transcatheter replacement was performed for aortic, mitral, tricuspid, and pulmonary valves, with closure of an iatrogenic atrial septal defect; follow-up at 15 months showed good valve function and thrombus resolution.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Case presentation

Echocardiographic findings and diagnosis

Procedure

Transcatheter valve deployment strategy

Closure of iatrogenic atrial septal defect

Postoperative course

Anticoagulation and outcomes

Imaging panels and supplementary information

CARDIOVASCULAR FLASHLIGHTS [https://doi.org/10.1093/eurheartj/ehaf757](https://doi.org/10.1093/eurheartj/ehaf757) Online publish-ahead-of-print 25 September 2025 Simultaneous transcatheter replacement of four cardiac valves in a 58-year-old female Changdong Zhang1,†, Mei Liu2,†, and Xiaoke Shang 1,* 1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, WuHan City, Hubei Province 430022, China; and 2Clinical Nutrition Department, Wuhan No.1 Hospital, No. 215 Zhongshan Avenue, WuHan City, Hubei Province 430022, China *Corresponding author. Tel: +86 188 2733 8233, Email: [14236338@qq.com](14236338@qq.com)[ ](14236338@qq.com)† The first two authors contributed equally to the study. A 58-year-old woman with rheumatic heart disease and triple bioprosthetic valve replacement (aortic, mitral, tricuspid; 2011) presented with one year of worsening dyspnoea, chest tightness, and palpitations. Thirteen years after surgery, she exhibited NYHA III heart failure, irregular rhythm, and biphasic murmur. Echocardiography revealed advanced degeneration with severe stenosis and regurgitation of all prostheses, pulmonary valve regurgitation, right atrial thrombus (4.4 × 2.8 cm), biatrial enlargement, and biventricular dysfunction (LVEF 32%, RVEF 19%, FAC 26%) . A fully percutaneous procedure was performed, sequentially deploying a balloon expandable PrizValve 23\# in the aortic, PrizValve 26\# in the mitral, PrizValve 29\# in the tricuspid, and a selfexpanding PT-Valve 40/26 in the pulmonary position. An iatrogenic atrial septal defect created during the procedure was closed to prevent paradoxical embolism (Panels A and B) . Postoperatively, warfarin maintained the international normalized ratio between 2 and 3. At 15 months, all valves functioned well with thrombus resolution (Panels C and D) . This is the first reported case of simultaneous trans catheter replacement of all four valves. Panel A: Immediate postoperative fluoroscopy demonstrated four transcatheter valves and closure of an iatrogenic atrial septal defect with an occluder. Panel B: CT after implantation of four valves and iatrogenic atrial septal defect closure. Panel C: Echocardiographic short axis view of the great arteries demonstrated no regurgitation of the implanted aortic and pulmonary valves and no flow acceleration across the pulmonary valve. Panel D: Echocardiographic apical four chamber view demonstrated no regurgitation of the implanted mitral and tricuspid valves. Supplementary data are not available at European Heart Journal online. All authors declare no disclosure of interest for this contribution. The data that support the findings of this study are available from the corresponding author upon reasonable request. No funding. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

FAQs

What clinical condition was the patient treated for in this case?

The patient had rheumatic heart disease with degeneration of prior bioprosthetic valves and severe stenosis and regurgitation across aortic, mitral, tricuspid, and pulmonary positions, accompanied by heart failure and a right atrial thrombus.

How were the four valves replaced during the procedure?

A fully percutaneous approach deployed a balloon-expandable PrizValve in the aortic, mitral, and tricuspid positions and a self-expanding PT-Valve in the pulmonary position, sequentially in that order.

What was done to address the iatrogenic atrial septal defect?

An iatrogenic atrial septal defect created during the procedure was closed using an occluder to prevent paradoxical embolism.

What outcomes were observed after surgery?

Warfarin maintained an INR between 2 and 3; at 15 months, all valves functioned well and the right atrial thrombus resolved.

Sep 30, 2026

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