Background: Rheumatic heart disease which requires triple valve replacement is seldom seen.To implant
three bioprostheses is rare, because malfunction of the bioprostheses occurs as a result of tissue degeneration in long-term follow up. Where there is stenosis of the valve, percutaneous balloon valvuloplasty can be performed as a palliative measurment. Bioprosthesis dysfunction with severe regurgitation, thrombosis or severe calcification requires valve replacement, but every subsequent operation carries a higher risk.
Case report: We present the case of a 62-year-old woman who underwent triple valve replacement (using
three bioprostheses). After she had developed tricuspid bioprpsthetic stenosis percutaneous
balloon tricuspid valvuloplasty was performed. One year later an aortic graft implatation ( due
to rupture of an aneurysm of the ascending aorta) with triple mechanical valve re-replacement
was performed, but reoperation did not succed.
Conclusions: Percutaneous balloon valvuloplasty (PBV) represents an alternative to surgical treatment for
stenotic bioprosthetic valves. Triple valve reoperation remains a serious problem with a high
mortality rate.

Keywords: multivalvular heart disease, triple valve replacement, bioprosthetic valve, percutaneous balloon tricuspid valvuloplasty