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Case Reports
. 2024 Feb 5;8(3Part B):253-257.
doi: 10.1016/j.case.2023.12.031. eCollection 2024 Mar.

Transseptal Mitral Valve-in-Valve-in-Valve

Blanaid Canavan  1   2 , Mark Higgins  1   2 , Dale J Murdoch  1   2 , Christopher Raffel  1   2 , Katherine Lau  1   2 , Gregory M Scalia  1   2 , Karl Poon  1   2
Affiliations
Case Reports

Transseptal Mitral Valve-in-Valve-in-Valve

Blanaid Canavan et al. CASE (Phila). .
No abstract available

Keywords: Hemolysis; Mitral valve; Transcatheter implantation; Valve-in-valve-in-valve.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Two-dimensional TEE, midesophageal long-axis (140°) view, systolic phase (A), demonstrates a well-seated mitral ViV (green arrow) following the initial procedure and (B) long-axis (157°) view, systolic phase, demonstrates migration of the ViV prosthesis (white arrow) 11 mm into the left atrium (LA) 1 year later.
Figure 2
Figure 2
Two-dimensional TEE, midesophageal view with color flow Doppler–guided continuous-wave spectral Doppler display, demonstrates (A) high MV mean pressure gradient (7 mm Hg, heart rate 33 beats/min) before mitral ViViV insertion and (B) reduced MV mean pressure gradient (4 mm Hg, heart rate 45 beats/min) immediately following mitral ViViV implantation.
Figure 3
Figure 3
Three-dimensional TEE, volume-rendered reconstruction display, en face view from the perspective of the LA, demonstrates (A) the initial 27-mm bioprosthetic MV (yellow arrow) and 23-mm ViV (red arrow), which has migrated toward the LA, and (B) the new 26-mm transcatheter valve implanted during the mitral ViViV procedure (white arrow) sitting within the initial ViV prosthesis.
Figure 4
Figure 4
Fluoroscopic images (A) immediately following previous ViV procedure, demonstrates 23-mm transcatheter valve edge (red outline) in line with islets of previous 27-mm bioprosthetic MV (green line). (B) After 1 year, migration of 23-mm transcatheter valve (red outline) from the islets of the bioprosthetic MV (green line). (C) Transcatheter 26-mm ViViV (white outline) well seated in comparison with bioprosthetic valve islets, preventing further migration of previously placed 23-mm ViV.
Figure 5
Figure 5
(A) Two-dimensional TEE, midesophageal long-axis (155°) view, systolic phase, demonstrates moderate PVR (red arrow) between 27-mm bioprosthetic MV and 23-mm ViV, with migration toward the LA. (B) Two-dimensional TEE, midesophageal long-axis (140°) view, demonstrates the absence of PVR (green arrow) following implantation of the new 26-mm transcatheter valve in previous ViV apparatus.
Figure 6
Figure 6
(A) Three-dimensional TEE, volume-rendered reconstruction with color flow Doppler display, en face view of the MV from the perspective of the LA, systolic phase, demonstrates paravalvular and supraskirtal regurgitation (white arrow) from the 9 o’clock to 1 o’clock positions arising between 27-mm bioprosthetic MV (yellow arrows) and 23-mm ViV (red arrows) and (B) resolution of the PVR following implantation of the new 26-mm ViViV.
See this image and copyright information in PMC

References

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