Left Atrial to Left Ventricular Bypass Using a Valved Conduit for Mitral Prosthesis-Patient Mismatch

A 72-year-old woman presented with dyspnea 2 years after mitral valve replacement with a 25-mm Epic bioprosthesis. Exercise echocardiography revealed a mean transvalvular gradient of 16 mm Hg, consistent with functional mitral stenosis due to prosthesis-patient mismatch. Because of the anticipated difficulties with insertion of a larger prosthesis, we proceeded with bypass of the mitral valve using a left atrial to left ventricular valved conduit. The patient had resolution of symptoms, and imaging demonstrated a widely patent graft. Left atrial to left ventricular bypass using a valved conduit is an effective treatment of mitral prosthesis-patient mismatch in the setting of severe mitral annular calcification.