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Updated: Jul 16, 2025

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter mitral valve implantation: Implications of interventional technique and 3D echocardiography for complex
Sankalp Sehgal1, Pritha Subramanyam2, Monica Ahluwalia3
1Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Cardiothoracic Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA, USA.
Abstract:
Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve-in-valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve-in-valve PVL are limited. We present a case of a symptomatic patient with severe valve-in-valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve-in-valve-in-valve implantation with a 29 mm Edwards® SAPIEN 3 valve via transseptal approach using three-dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve-in-valve PVL closures.
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