Case and Plan:
77-year-old female presents with progressive dyspnea, decreased exercise tolerance, and lower extremity swelling and new onset Afib. Past medical history is significant for HOCM, Severe MR s/p MVR with a 27 mm Carpentier- Edwards Magna and septal myomectomy in 2014, HFrEF with LVEF 21%, hyperlipidemia, tachy-bradycardia syndrome s/p PPM. She was found to have transmitral gradient of 9 mmHg at rest on TTE. TEE shows severe prosthetic stenosis with an MVA 0.7 sq cm on 3D planimetry with mitral prosthesis degeneration with leaflet immobility and possible small LAA clot. Heart team was consulted and the patient was high risk for redo MVR. Therefore, she is recommended for transfemoral VIV-TMVR using 26 mm + 2cc SAPIEN-3 Ultra Resilia valve with possible sentinel device.
