An 87-year-old man with chronic obstructive pulmonary disease (COPD) and chronic renal insufficiency presented with New York Heart Association functional class III symptoms and severe mixed tricuspid valve disease. Given complexity of his anatomy and high surgical risk, he was selected for transcatheter tricuspid valve replacement (TTVR) with a 48 mm Evoque valve (Edwards Lifesciences, Irvine, CA). Because of severe COPD from a 100-pack year smoking history, the procedure was performed under conscious sedation with intracardiac echocardiography (ICE) guidance. Preprocedural fluoroscopy and computed tomography revealed a heavily calcified tricuspid valve (Fig. 1, Video 1), and echocardiography demonstrated both significant stenosis and severe tricuspid regurgitation (Fig. 2, Video 2).