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

Figure 5

Transcatheter mitral valve in a St. Jude medical ring (TMViR) with a paravalvular ring leak. A 62-year-old female patient with a degenerated 27-mm MV St. Jude medical band post-MV repair and CABG with an associated AF. (a) TEE and color 3D-TEE 3 months post-TMViR with a SAPIEN-3 26 mm valve with a moderate to severe lateral paravalvular leak at 9–10 o’clock. (b) Fluoroscopy shows transseptal puncture through an 8.5F-SL sheath, followed by the crossing of a 5F-MP catheter on a 0.035-inch curved Terumo guidewire through the paravalvular leak from the LA side to the LV side. The guidewire was exchanged for two 0.035-inch/260 extra-stiff Confida™ guidewires, with balloon dilatation of the transseptal puncture using a 12 mm balloon. (c) Fluoroscopy shows the deployment of an Amplatzer™ muscular VSD 12 mm device and an Amplatzer™ vascular plug II 10 mm device, with post-TMViR balloon dilatation with an Edwards balloon 25 mm. The valve migrated and finally, the patient underwent surgical MV replacement. AF: atrial fibrillation; 3D: three-dimensional; LA: left atrium; LV: left ventricle; TMViR: transcatheter mitral valve-in-ring; TEE: transesophageal echocardiography; VSD: ventricular septal defect.

(a)

(b)

(c)