Transcatheter Mitral Valve Replacement in High-Surgical Risk Patients: A Single-Center Experience and Outcome

Figure 4

Transcatheter mitral valve in a degenerated Hancock™ II (Medtronic) valve (TMViV). A 66-year-old diabetic male patient, with ulcerative colitis, had a degenerated bioprosthetic 29 mm Hancock™ II MV with an associated AF. TEE and 3D-TEE show a degenerated bioprosthetic 29 mm Hancock™ II MV (severe MS and severe MR). (b) Fluoroscopy shows an 8.5F-agilis™ sheath was flexed and directed towards the degenerated bioprosthetic MV. A 5F-MP catheter over a 0.035-inch curved Terumo guidewire crossed the MV to the LV. The wire was exchanged with a 0.035-inch/260 extra-stiff Confida™ guidewire and a 0.035-inch/260 J-curve super-stiff Amplatz™ guidewire. (c) Fluoroscopy shows TMViV implantation of an Edwards SAPIEN-3 26 mm valve within the degenerated bioprosthetic MV, followed by post-TMViV distal valve flaring. D: TTE: an Edwards SAPIEN 3 26 mm valve in the MV position with normal Pg, and trivial with a valvular leak. AF: atrial fibrillation, 3D: three-dimensional, MR: mitral regurge, MS: mitral stenosis, MV: mitral valve, MVA: mitral valve area, Pg: pressure gradient, TMViV: transcatheter mitral valve-in-valve, TEE: transesophageal echocardiography, TTE: transthoracic echocardiography.

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