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Valve-in-Mitral Annular Calcification Transcatheter Mitral Valve Replacement After Thrombosis of Extracardiac

Adam M Tawney1, Jason P Schott1, Robert D Safian1

  • 1Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan, USA.

JACC. Case Reports
|November 21, 2022
PubMed

Insights

This case study details a complex heart condition involving mitral valve issues and hypertrophic obstructive cardiomyopathy. Treatment involved multiple surgical interventions, including a novel transcatheter valve replacement.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Severe mitral annular calcification (MAC) and associated mitral stenosis/regurgitation present significant therapeutic challenges.
  • Hypertrophic obstructive cardiomyopathy (HOCM) and subaortic membrane further complicate the management of complex valvular heart disease.
  • Multivalvular involvement necessitates innovative and often staged treatment strategies.

Observation:

  • A patient presented with severe MAC, mitral stenosis/regurgitation, HOCM, and a subaortic membrane.
  • Initial treatment involved a valved left atrium-to-left ventricle conduit, septal myectomy, and membrane resection.
  • Postoperative conduit thrombosis occurred, requiring further intervention.

Findings:

  • Successful valve-in-MAC transcatheter mitral valve replacement (TMVR) was performed after conduit thrombosis.
  • Anterior mitral leaflet laceration was necessary to relieve residual left ventricular outflow tract obstruction.
  • This combined approach addressed multiple complex cardiac pathologies.

Implications:

  • This case highlights the feasibility of TMVR in patients with severe MAC and prior complex surgical interventions.
  • The management strategy demonstrates adaptability in addressing complications like conduit thrombosis and persistent outflow obstruction.
  • Successful outcomes underscore the potential for advanced interventional techniques in managing complex cardiovascular conditions.

Keywords:
INR, international normalized ratioLAMPOON, laceration of the anterior mitral leaflet to prevent outflow obstructionLVOT, left ventricular outflow tractMAC, mitral annular calcificationTMVR, transcatheter mitral valve replacementcomputed tomographyechocardiographyhemodynamicsmitral valvepulmonary hypertensionvalve replacement

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