Valve-in-valve transcatheter mitral valve replacement procedure in prosthetic valve stenosis

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound: A Report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the

Thrombolytic therapy for prosthetic valve thrombosis in children: two case reports and review of the literature

Bioprosthetic Valve Thrombosis while on a Novel Oral Anticoagulant for Atrial Fibrillation

Quite often the iatrogenic atrial septal defect created after percutaneous transcatheter mitral valve replacement procedures is closed with an atrial septal occluder device thus precluding further transseptal interventions if required. In this case report, we describe a patient who previously underwent a valve-in-valve transcatheter mitral valve replacement and iatrogenic atrial septal defect closure with an Amplatzer device, who developed severe prosthetic mitral valve stenosis. This patient required a second percutaneous valve-in-valve in-valve procedure with a transseptal puncture in the presence of an atrial septal occluder device.

Pannus formation by the endothelial tissue overlapping the prosthetic mitral valve is a rare condition requiring surgical intervention in patients undergoing mitral valve replacement. In this article, we present a 54-year-old female patient admitted with the complaints of fatigue and dyspnea. Echocardiographic examination revealed prosthetic mitral valve stenosis, tricuspid valve stenosis and regurgitation and aortic valve stenosis following the previous mitral valve replacement. Transvalvular pannus resection with removal of prosthetic mitral valve stenosis, aortic valve replacement and tricuspid commissurotomy were performed. The patient was discharged on postoperative day 11 without any events.

Case presentation: A 28-year-old woman with known mitral stenosis (MS) who was not taking antibiotic prophylaxis presented with new onset of chest pain, atrial fibrillation, and “heart failure.” She was treated for “heart failure” and converted spontaneously to sinus rhythm. Echocardiographic/Doppler studies showed a mitral valve gradient (MVG) of 7, a mitral valve area (MVA) of 1.2 cm2, 2+ mitral regurgitation (MR), no tricuspid regurgitation, normal left ventricular (LV) size and function, no left atrium (LA) thrombus, and a mitral valve score (University of Southern California [USC] scoring system) of 1, with no calcium in the commissures. At cardiac catheterization, mean pulmonary artery (PA) wedge was 23 mm Hg, mean PA pressure was 25 mm Hg, MVG was 10 mm Hg, and MVA was 1.2 cm2. On exercise, mean PA wedge was 30 mm Hg, mean PA pressure was 55 mm Hg, and MVG was 18 mm Hg. On angiography, the LV end-diastolic volume was 80 mL/m2, ejection fraction was 0.48, and 2+ MR, with normal coronary arteries. After catheter balloon commissurotomy (CBC), the MVA was 2.0 cm2, mean PA wedge was 13 mm Hg, and mean PA pressure was 20 mm Hg, with no MR. Her discharge medications were penicillin V 250 mg twice daily and antibiotic prophylaxis for prevention of infective endocarditis. ### Current Evaluations and Management of MS In almost all patients, MS is the result of previous rheumatic carditis with valve involvement. #### Severity of MS The relationship of the MVG as a function of the rate of mitral valve flow per diastolic second for various MVAs is shown in Figure 1. The threshold of onset of pulmonary edema is ∼20 mm Hg. Assuming a normal mean LV diastolic pressure (LVDP) of 5 mm Hg, a mean MVG of 20 mm Hg would be necessary1 to maintain …

Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.

A 65-year–old man was admitted with recurrent pulmonary edema. At the age of 23, 42 years before his admission, he had had an aortic valve replacement with a “ball-and-cage” valve for severe aortic stenosis. He had suffered a postoperative hemorrhagic stroke with right hemiparesis but had been doing well on warfarin for 42 years. Echocardiography demonstrated a perfectly functioning prosthetic aortic valve with peak transvalvular gradient of 23 mm Hg and mean gradient of 13 mm Hg with no aortic regurgitation (Figure 1, Movie I). There was also severe rheumatic mitral valve stenosis. Coronary angiography showed insignificant coronary disease, and on fluoroscopy an unusual …

Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.

Redo aortic valve replacement in twin pregnancy: navigating high-risk cardiac surgery with maternal and fetal success – A case report

Cardiac Anesthesiologist and Global Capacity Building to Tackle Rheumatic Heart Disease

Stenosis of bioprosthetic or mechanical aortic valves can occur due to valve degeneration, pannus formation, thrombosis, and endocarditis. Prosthetic valve stenosis is characterized by elevated trans-aortic velocities and gradients; however, it is imperative to realize that the mere presence of an elevated gradient across an aortic valve prosthesis is not sufficient to diagnose prosthesis stenosis. This chapter will review the valve design and types, causes of prosthetic aortic valve stenosis, approach to evaluate patients with elevated trans-aortic prosthesis gradient, as well as the complimentary role of CT and MRI.

Percutaneous transcatheter mitral valvuloplasty is the indicated treatment of choice for symptomatic native mitral valve stenosis, but there have been limited reports of successful procedures of balloon valvuloplasty for bioprosthetic mitral valve stenosis. We present the case of a 62-year-old woman suffering from progressive dyspnea due to bioprosthetic mitral valve stenosis. The measured mean pressure gradient across the mitral valve was 30 mmHg and the mitral valve area was 0.73 cm(2). Redoing mitral replacement was considered high risk and was refused by the patient. Percutaneous balloon valvuloplasty was performed with an Inoue balloon catheter inflated to 20 mm. The patient's symptoms immediately improved after the procedure, with no procedure-related complications. The mean pressure gradient across the valve decreased to 19 mmHg, and the mitral valve area increased to 1.21 cm(2) in postprocedural echocardiography. We conducted a literature search and identified 26 cases of balloon valvuloplasty for degenerated bioprosthetic valves. Of these, 14 cases were bioprosthetic mitral valves, and the results were favorable. However, more case reports are required to establish an evidence base for future expert recommendation of balloon valvuloplasty of prosthetic mitral valve. Meanwhile, balloon valvuloplasty will serve a niche role in highly selected patients with prosthetic mitral valve stenosis.

Lutembacher’s Syndrome with Small Atrial Septal Defect Diagnosed by Transthoracic and Transesophageal Echocardiography that Underwent Mitral Valve Replacement

Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy