TRANSCATHETER MITRAL VALVE-IN-VALVE IN RING WITH VENTRICULAR SEPTAL DEFECT OCCLUDER ASSIST FOR PERIVALVULAR LEAK

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Mitral ring annuloplasty failure is uncommon, however, ring dehiscence accounts for 42% of occurrences and allows for detrimental mitral regurgitation (MR). Transcatheter mitral valve replacement (TMVR) has been described as an effective treatment for ring annuloplasty failure with trans-ring and para-ring MR. Case An 86-year-old male with medical history of severe MR post incomplete ring annuloplasty presented with three months of progressive dyspnea. Transesophageal echocardiogram (TEE) demonstrated severe eccentric MR at P2 and originating focally at the site of ring dehiscence from the native mitral annulus. Decision-making Given comorbid conditions and re-do sternotomy status, minimally invasive management was pursued. A transcatheter edge-to-edge repair was aborted due to mitral anatomical limitations. Following, a 29 mm valve was deployed without significant resolution of perivalvular leak (PVL). An additional 29 mm valve was placed with persistent PVL in the posterolateral annulus of the dehisced annuloplasty ring. Ultimately, three ventricular septal defect occluders were placed (8mm and two 10mm) within the dehisced area to completely abolish the PVL. Conclusion TMVR has been described as an effective, minimally invasive option for mitral ring annuloplasty failure. However, incomplete annular apposition in TMVR remains a procedural complication. Small caliber ventricular septal occluder devices may serve as a sufficient adjuvant implant for persistent PVL. [Formula presented]

Volume

83

Issue

13

First Page

4233

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