Unusual presentation of isolated tricuspid valve disease

Here we present a case 20 year old boy with isolated calcific tricuspid stenosis (TS) and tricuspid regurgitation (TR) underwent TV replacement with bioprosthetic valve. After 3 months patient was presented in our emergency with sudden cyanosis, dyspnea at rest, TS and the large patent foramen ovale with large right to left shunt. Patient was re-operated, bioprothetic valve was explanted and mechanical valve was implanted. Patient developed acquired dysfibrogenemia in early post-op period with valvular dysfunction.