PO-717-05 PROPHYLACTIC AND PREVENTIVE RADIOFREQUENCY SEPTAL ABLATION TO REDUCE THE POSSIBILITY OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION POST-MITRAL VALVE REPLACEMENT

Abstract

The patients who have severe mitral annulus calcification leading severe mitral stenosis often are eldery and have comorbidities which increase surgical risk of stroke, embolization, and bleeding complications. Radiofrequency ablation is another prophylactic and preventive option for reducing the possibility of left ventricular outflow tract obstruction (LVOTO) post-mitral valve replacement patients who are not suitable for surgical myomectomy or alcohol septal ablation. N/A We report on a 78-year-old woman with a history of symptomatic severe mitral valve stenosis with a mean gradient of 20 mmHg. She was not a surgical candidate for mitral valve and preparing for a valve-in-valve percutaneous mitral valve replacement. Computer tomography revealed left ventricular septal bulge appeared to have a significant LVOTO post-valve replacement. However she was not a candidate for surgical myomectomy due to her age and comorbidities, and she also had no anatomical option to consider for alcohol septal ablation. Heart team discussion decided to do radiofrequency ablation (RFA) to reduce the possibility of LVOTO post-valve replacement. RFA was performed in the left ventricular outflow tract (LVOT) using an irrigated-tip ablation catheter; the target site was identified along the LV septal hypertrophy using intracardiac echocardiography (ICE) and electroanatomical CARTO mapping. ICE demonstrated thinning of the ablated regions. The LV electrograms were noted during ablation and the size was decreasing from 0.63 mV to 0.15 mV. After RFA, she underwent minimally invasive open left-atrial transcatheter mitral valve replacement-in-MAC via right minithoracotomy with a 29-mm Edwards Sapien 3 bioprosthetic valve. Transthoracic echocardiography after surgery showed normal left ventricular systolic function with a mean mitral valve pressure gradient of 5.63 mmHg and no paravalvular leakage. The LVOT resting gradient of 17 mmHg. LVOTO could be one of the complications after valve replacement. Radiofrequency septal ablation is a novel prophylactic and preventive procedure in reducing the possibility of the left ventricular outflow tract obstruction post-mitral valve replacement and decreasing the risk of morbid and mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)