TMVR with 29mm Sapien-3 Valve – January 2018

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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Comments

Comments (3)
christine gasperetti
09 Jan, 2018

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

Reply
Prashanth katrapati
09 Jan, 2018

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

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Gaurav chaudhary
09 Jan, 2018

Excellent case..
Great virtual learning platform
Thanks

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