Case and Plan:
73-year-old female presents with progressive dyspnea NYHA class III over the last 6 months. Past medical history of RHD with severe MS and AS s/p bio-prosthetic MVR (25mm CE Magna Ease Pericardial), AVR (21mm CE Magna Ease Pericardial), TV repair (30mm annuloplasty ring) and single chamber PPM on 7/1/2019, chronic AFib (on Warfarin), hypertension, hypothyroidism, hyperlipidemia, severe obesity (BMI 42.3), and PAD s/p PTA (2021). A recent TEE showed degeneration of the mitral bio-prosthesis with severe mitral stenosis mean gradient was 12mmHg, moderate bioprosthetic aortic stenosis, severe pulmonary hypertension and LVEF 55%. Patient was evaluated by the Heart Team and was deemed high risk for re-op surgical mitral valve replacement due body habitus and poor functional status. The patient is now planned for a mitral ViV TMVR with a 26mm(+2cc) SAPIEN-3 Ultra Resilia valve with valve fracture via transfemoral approach.
