Early improvement in right ventricular dysfunction following transseptal transcatheter mitral valve-in-valve replacement.

Document Type

Article

Publication Date

3-24-2020

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Bioprosthetic mitral valve failure is often associated with pulmonary hypertension, leading to right ventricular (RV) strain and functional tricuspid regurgitation (TR). Transcatheter mitral valve-in-valve replacement (TMVR) is a reasonable alternative in patients with high surgical risk, but the extent to which RV function improves following TMVR is unclear. Case: A 62-year-old man with a history of tissue mitral valve replacement 10 years prior to admission presented with acute biventricular heart failure. Echocardiography revealed flail calcified mitral leaflets with severe mitral stenosis and regurgitation (Figure 1A-B), massive TR (Figure 1C) and marked RV dilation with leftward septal bowing (Figure 1D). Invasive hemodynamics revealed mean transmitral gradient 11 mmHg and left atrial v-wave 45 mmHg, consistent with severe mitral stenosis and insufficiency (Figure 1E). Decision-making: The risk of redo sternotomy, surgical mitral valve replacement and tricuspid valve repair was considered prohibitive. He was referred for TMVR. Transseptal access was used to implant a 29 mm S3 valve within the degenerated mitral prosthesis, resulting in obliteration of transmitral gradient and reduction in v-wave to 25 mmHg (Figure 1F). Echocardiography 3 days later revealed significant reduction in RV size and TR severity (Figure 1G-J). Conclusion: TMVR resulted in early improvement in RV function and TR, likely due to acute RV unloading via reduction in pulmonary venous hypertension.

Volume

75

Issue

11 Supplement 1

First Page

2981

Last Page

2981

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