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Updated: Sep 12, 2025

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Delayed Mitral Prosthesis Dehiscence Following Transcatheter Aortic Valve Replacement
Sahri Kim1, Hyun Jung Koo2, Jung-Min Ahn3
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Background:
The presence of preexisting mitral prosthesis in transcatheter aortic valve replacement (TAVR) raises concerns about potential valve interaction; however, this issue remains insufficiently explored.
Case Summary:
A 79-year-old man presented with hemolysis 8 months post-TAVR. He had a history of mitral valve replacement 16 years prior. Further investigation revealed severe paravalvular leakage of the mitral valve, which was attributed to the dehiscence of the mitral prosthesis. A retrospective review of pre-TAVR computed tomography images identified a subtle, previously undetected defect in the mitral-aortic intervalvular fibrosa, likely masked by neointima.
Discussion:
We hypothesize that chronic mechanical stress between the TAVR device and the mitral-aortic intervalvular fibrosa causes progressive damage, resulting in delayed mitral valve dehiscence and hemolysis.
Take-Home Message:
Careful preprocedural evaluation and prolonged postprocedural surveillance are essential for patients with preexisting mitral prostheses after TAVR due to the potential for delayed long-term complications.
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