A 67-year-old woman with remote history of endocarditis s/p tricuspid valve repair and mechanical aortic valve replacement was referred for second opinion and management of new severe symptomatic tricuspid valve stenosis resulting in progressive debilitating congestive heart failure (HF). The patient was approved by the heart team to undergo redo open heart for surgical repair of the tricuspid valve. Intraoperative technical challenges were met to repair the tricuspid valve. In turn, the native valve was resected and a 33 mm On-X mechanical valve prosthesis (On-X Life Technologies, Austin, TX, USA) was implanted. The patient’s post-operative course was complicated by recurrent haemoptysis related to endotracheal tube trauma, prolonged mechanical respiratory support, acute kidney injury, and cardiogenic shock. While unable to anticoagulate, increasing requirements of inotropic and vasopressor support were noted. On the fifth post-operative day, 2D examination revealed single leaflet fixation of the tricuspid mechanical prosthesis resulting in severe stenosis, along with moderate size iatrogenic ventricular septal defect (VSD) not previously seen and later confirmed on transesophageal echocardiography (TEE). The mechanism for the leaflet dysfunction remained unclear. There appeared to be no evidence of leaflet thrombosis. The left ventricle and mechanical aortic valve function remained preserved. Using a heart team approach, it was felt that surgical re-exploration to address the dysfunctional mechanical tricuspid valve and VSD would be prohibitive. A transcatheter assessment with ad hoc intervention was considered. Upon obtaining consent from the patient’s next of kin, the patient was emergently taken to the cath lab for further evaluation and management. The patient was transferred to the cardiac catheterization laboratory in severe haemodynamic collapse. Initial fluoroscopic examination of the heart confirmed the echocardiographic results of an immobile septal leaflet of the recently implanted mechanical tricuspid valve. A 9 Fr St. Jude Viewmate intracardiac echo-catheter was used to further assess the TV function and assist with transseptal puncture. Transseptal access allowed for LV and RV intracardiac pressure assessment across the VSD. Similarly, simultaneous right atrium (RA) and RV pressure gradients obtained confirmed the presence of severe TS with a mean gradient of 11 mmHg. Initial attempts were made to force open the fixated tricuspid valve leaflet with a 6 Fr multiple purpose catheter from the right femoral vein. Despite several attempts using different angles and techniques, it was unsuccessful. ‘Valvuloplasty’ was therefore pursued. A 0.035” Terumo angled-glidewire was carefully manoeuvered antegrade across a 6 Fr MPA catheter, between the aperture of two mechanical leaflets and into the pulmonary artery. The Multipurpose (MPA) catheter was then exchanged for an 8 × 40 mm Mustang OTW angioplasty balloon (Boston Scientific, Natick, MA, USA) was then advanced across the mechanical valve and inflated gradually at nominal pressure (8 ATM). A single inflation resulted in successful restoration of valve leaflet function. Fluoroscopic examination with repeat haemodynamics confirmed successful procedural results with complete normalization in valve function and no residual stenosis. Percutaneous closure of the VSD was subsequently pursued following balloon valvuloplasty. Significant temporary improvement in haemodynamic function ensued over the following days. Unfortunately, despite all heroic measures undertaken, the patient succumbed to her illness after multisystem organ failure 5 days later.