Details

Autor(en) / Beteiligte

• Lima, Maria Rita
• Brito, João
• Almeida, Manuel
• Teles, Rui Campante

Titel

Combined transcatheter aortic valve and tricuspid valve‐in‐valve implantation in a patient with a mitral mechanical prosthesis

Ist Teil von

• Catheterization and cardiovascular interventions, 2024-06, Vol.103 (7), p.1159-1164

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2024

Quelle

Wiley Online Library

Beschreibungen/Notizen

• Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high‐surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis “ring.” Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro‐aortic distance. Performing a second major procedure, such as tricuspid valve‐in‐valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83‐year‐old woman with rheumatic heart disease, with previous implantation of a Bjork–Shiley monoleaflet mitral prosthesis, and Carpentier‐Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease.