Structural heart cases
TMVR with 29mm Sapien-3 Valve – January 2018
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67 year old male presents with worsening dyspnea on exertion (NYHA class III) and edema over the last 4 weeks. Past medical history is significant for severe MR s/p bioprosthetic MVR in 1997 with subsequent degeneration and replacement with a #29 Hancock II porcine bioprosthetic valve in 2008. Patient had mitral paravalvular leak s/p transcatheter closure. Also had severe TR s/p Tricuspid Valve Repair (#26 Cosgrove Band) 2008, atrial flutter and atrial fibrillation s/p multiple ablations and s/p Cryomaze in 2008, cirrhosis, CKD stage 3, remote GI bleed, COPD, and severe pulmonary hypertension. A recent TEE showed a severely degenerated mitral valve bioprosthesis with a flail leaflet and severe transvalvular MR along with moderate bioprosthetic MV stenosis (MG = 9-11 mmHg). The patient was evaluated by the Heart Team and due to his multiple comorbidities and STS mortality of 7.12%, was found to be extreme risk for a 3rd reoperation. Patient is now planned for a ViV TMVR with a 29 mm Sapien-3 valve via transfemoral approach.

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3 thoughts on “TMVR with 29mm Sapien-3 Valve – January 2018”

  1. christine gasperetti says:

    a beautiful case (again)
    very instructive step by step very clear
    thank you!

  2. Prashanth katrapati says:

    Can you please comment on why the mean mitral gradient increased to 12 mm hg post case? The V-waves were still at 50 mm Hg, so there must also be some element of MR that was not visualized on TEE? Any comments

  3. Gaurav chaudhary says:

    Excellent case..
    Great virtual learning platform
    Thanks


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