Korean Circ J.  2014 Sep;44(5):344-347. 10.4070/kcj.2014.44.5.344.

Transcatheter Aortic Valve Implantation in a Patient with Previous Mitral Valve Replacement

• Moon SW
• Ko YG
• Hong GR
• Lee S
• Chang BC
• Shim JK
• Kwak YR
• Hong MK

• KMID: 2223874
• DOI: http://doi.org/10.4070/kcj.2014.44.5.344

Abstract

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve.

Keyword

Aortic valve stenosis; Catheters; Heart valve prosthesis; Prosthesis implantation; Mitral valve

MeSH Terms

Aortic Valve Stenosis
Aortic Valve*
Catheters
Heart Valve Prosthesis
Humans
Mitral Valve*
Prosthesis Implantation
Thoracic Surgery

Figure

• 

  Fig. 1 Pre-procedural transthoracic echocardiogram with a parasternal long axis view of the heavily calcified aortic valve with valve area of 0.41 cm2. A: without color Doppler. B: with color Doppler. AV: aortic valve, LA: left atrium, LV: left ventricle, RV: right ventricle, pMV: prosthetic mitral valve.

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  Fig. 2 Fluoroscopic images of transcatheter aortic valve implantation using a CoreValve. A: partially deployed CoreValve. B: completely deployed CoreValve. TEE: transesophageal echocardiography probe, pMV: bileaflet mechanical prosthetic mitral valve (dotted circle), W: superstiff wire inserted into the left ventricle, TP: temporary pacemaker inserted into the right ventricle.

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  Fig. 3 Post-procedural images of transesophageal echocardiography (135 degree long axis view). A: without color Doppler. B: with color Doppler. The implanted CoreValve (arrowheads) did not interfere with the mechanical mitral valve (white arrow). The black arrows indicate a mild degree of paravalvular leak. Ao: aorta, LA: left atrium, LV: left ventricle, pMV: prosthetic mitral valve.

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  Fig. 4 Pressure gradient over the aortic valve as measured by transthoracic echocardiography. A: before TAVI. B: after TAVI. Peak/mean pressure gradient was reduced from 54/30 mm Hg to 18/8 mm Hg. TAVI: transcatheter aortic valve implantation.

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