Patients with congenital tricuspid valve problems or post surgical complications often need biological vale implants quite early on in child hood with risk of size/growth mismatch, valve degeneration and severe stenosis or mixed disease, which expose them to the high risk of multiple redo surgeries.

We report 3 cases of transcatheter tricuspid valve in valve implants in the last 18 months, additionally one of them had a percutaneous pulmonary valve implantation (PPVI) at the same procedure after ensuring a widely patent tricuspid valve. Patient ages 19, 11, 26 yrs.

The failing valves in all 3 were a perimount valves, sizes 23 to 31mm.

The inserted valves were Sapien Edwards valves 20 to 29 mm, we used the ViV surgically oriented app which guides the best size, the wire park in the on of the branch pulmonary artery over which the valve mounted onto a balloon within the IVC then manipulated into position within the old valve. Rapid LV pacing would reduce the cardiac output to ensure minimal valve movements during implantation. The valve is deployed with fluoroscopy and TOE guidance, excellent final result with Drop of the mean PG across the valve from 9 to 1 mmHg with no valvar or paravalvar leak,

Conclusion Percutaneous Tricuspid valve implant is a save procedure in patients with failed surgical biological tricuspid valves, and seems to be the logical way forward to avoid redo surgical procedures and more scarring of the right atrium and right ventricle, heart block and arrhythmias.