CASE & Plan:
A 69-year-old female presents with progressive dyspnea, decreased exercise tolerance,
and lower extremity swelling. Past medical history is significant for MR s/p MVR with a
29 mm Perimount 6900 valve in 2008, ICM with EF40%, CAD s/p multiple PCIs, TIA,
PAD, and DM. She was found to have transmitral gradient of 7 mmHg at rest. Persistent
high gradient despite trial of anticoagulant for presumed mitral-HALT for 10 weeks. TEE
shows mitral prosthesis degeneration with leaflet immobility. Heart team was consulted
and the patient was high risk for redo MVR. Therefore, she is recommended for
transfemoral VIV-TMVR using 29 mm + 2cc Sapien-3 Ultra Resilia valve.
