STRUCTURAL HEART DISEASE - Valvular Intervention: Mitral or Tricuspid
Chase the Leak - A Case of Valve-in-Ring with Mitral PVL Closure
Chak Yu So1, Guson Kang2, Marvin Eng3
Prince of Wales Hospital, Hong Kong, China1, VAPAHCS & Stanford Health Care, USA2, Henry Ford Hospital, USA3,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
CT is a 75-year-old jehovah's witness with a history of Ca breast, chemotherapy induced cardiomyopathy, atrial fibrillation and severe mitral regurgitation with prior mitral valve annuloplasty using a 30mm St Jude Saddle Ring. She presented with 6 months of worsening shortness of breath.
Relevant Test Results Prior to Catheterization
Her echocardiogram found recurrent severe mitral regurgitation due to leaflet tethering and a partial mitral ring dissidence, and LVEF 30%.
Relevant Catheterization Findings
Heart team deems her inoperable candidate due to frailty and status of jehowah's witness refusing any blood product transfusion. Mitral valve edge to edge repair was thought to be challenging due to presence of mitral ring, restricted posterior leaflet and shadowing by the ring in imaging the posterior leaflet during intra-procedural TEE. In view of these, heart team recommended for transseptal transcatheter mitral valve replacement - valve in ring, with transcatheter ring dissidence repair.
Learning points: 1. TMVR with PVL Closure is feasible to tackle recurrent mitral regurgitation post mitral ring annuloplasty with ring dehiscence. 2. Obtaining access across the ring dehiscence before TMVR valve implantation is important to avoid wiring crossing into newly implanted valve stent strut3. Valve in ring TMVR could result in ring dehiscence, commonly at trigone region4. Be ready to chase the leak in all VIR TMVR