Roberta De Rosa, MD, Dietmar Schranz, MD, Andreas M

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Again, Two Melodies in Concert: Transcatheter Double Valve Replacement in Hedinger Syndrome Roberta De Rosa, MD, Dietmar Schranz, MD, Andreas M. Zeiher, MD, Stephan Fichtlscherer, MD The Annals of Thoracic Surgery Volume 104, Issue 1, Pages e61-e63 (July 2017) DOI: 10.1016/j.athoracsur.2017.01.063 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Representative preintervention echocardiographic views of pulmonary valve (PV) replacement. (A) Stenosis of bioprosthesis in pulmonary position: PV peak gradient, 48 mm Hg; PV peak velocity, 349 cm/s; and tricupid valve (TV) replacement. (B) Regurgitation of bioprosthesis in tricuspid position in color Doppler view. (C) Stenosis of bioprosthesis in tricuspid position: TV mean gradient, 12 mm Hg; estimated pulmonary artery systolic pressure, 53 mm Hg + central venous pressure (CVP). The Annals of Thoracic Surgery 2017 104, e61-e63DOI: (10.1016/j.athoracsur.2017.01.063) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Representative frames of transcatheter Melody valve implantation in pulmonary (A–D) and tricuspid (E–H) positions. (A, B) Implantation of Melody valve in pulmonary replacement. (C, D) Postintervention pulmonary angiographic view. (E, F) Implantation of Melody valve in tricuspid replacement. (G, H) Postintervention angiographic view of right chamber. The Annals of Thoracic Surgery 2017 104, e61-e63DOI: (10.1016/j.athoracsur.2017.01.063) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Representative postintervention echocardiographic views of pulmonary valve (PV). (A) Absence of PV regurgitation. (B) PV peak velocity, 285 cm/s, and tricuspid valve (TV). (C) TV mean gradient, 4 mm Hg; absence of relevant TV regurgitation. The Annals of Thoracic Surgery 2017 104, e61-e63DOI: (10.1016/j.athoracsur.2017.01.063) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions