Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses

Reoperative aortic valve replacement is associated with increased morbidity. Valve-in-valve transcatheter aortic valve replacement offers a less invasive alternative to traditional reoperation. However, cases of valve failure after valve-in-valve transcatheter aortic valve replacement represent a complex surgical challenge. We present a case requiring a complex reoperative aortic valve replacement due to structural valve deterioration after multiple previous valve-in-valve transcatheter aortic valve replacements. We performed removal of 3 previous valve-in-valve transcatheter aortic valves, bioprosthetic leaflet excision, and intentional bioprosthetic fracture under direct vision for annular enlargement. This facilitated direct insertion of a new transcatheter aortic valve for expedient and successful management of recurrent aortic stenosis in a very high-risk patient. Creative use of leaflet excision, intentional bioprosthetic fracture, and insertion of a new transcatheter aortic valve under direct vision, proved efficient and successful in a high-risk patient with few surgical options.

Download Full-text

Transcatheter Mitral Valve Devices – Functional Mechanical Designs

Interventional Cardiology Review ◽

10.15420/icr.2011.9.1.49 ◽

2011 ◽

Vol 9 (1) ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Chad Kliger ◽

Keyword(s):

High Risk ◽

Mitral Valve ◽

High Risk Patient ◽

Efficacy And Safety ◽

Invasive Treatment ◽

Complex Disorder ◽

Transcatheter Mitral Valve Replacement ◽

Suitable Treatment ◽

Valve In Valve ◽

Mitral Apparatus

Mitral regurgitation is a complex disorder involving a multitude of components of the mitral apparatus. With the desire for less invasive treatment approaches, transcatheter mitral valve therapies (TMVT) are directed at these components and available at varying stages of development. Therapeutic advancements and the potential to combine technologies may further improve their efficacy and safety. Transcatheter mitral valve replacement, while preserving the mitral apparatus, may emerge as an alternative or even a more suitable treatment option. In addition, early data on transcatheter mitral valve-in-valve and valve-in-ring implantation are encouraging and this approach may be an alternative to reoperation in the high-risk patient. This review details the expanding functional mechanical designs of current active TMVT.

Download Full-text

Interventional Echocardiography of the MV: What the Interventionalist Wants to Know

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218778822 ◽

2018 ◽

Vol 23 (1) ◽

pp. 37-47 ◽

Cited By ~ 2

Author(s):

Ludmil Mitrev ◽

Nayan Desai ◽

Ahmed Awad ◽

Sajjad Sabir

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

The Past ◽

Interventional Echocardiography ◽

Valve In Valve ◽

Procedural Guidance ◽

Valve Implantation ◽

Transcatheter Interventions

The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.

Download Full-text