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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.
JACC. Case Reports
|August 8, 2025
Summary
Transcatheter aortic valve replacement (TAVR) can lead to delayed mitral valve dehiscence and hemolysis in patients with prior mitral valve replacement. Careful pre-TAVR imaging and post-TAVR monitoring are crucial for early detection of complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- The interaction between TAVR devices and pre-existing mitral prostheses is not well understood.
- Concerns exist regarding potential complications arising from this valve-in-valve interaction.
Observation:
- A 79-year-old male presented with hemolysis 8 months after TAVR.
- He had a history of mitral valve replacement (MVR) 16 years prior.
- Severe mitral paravalvular leakage was identified, caused by mitral prosthesis dehiscence.
Findings:
- Retrospective review of pre-TAVR CT scans revealed a defect in the mitral-aortic intervalvular fibrosa.
- This defect was likely masked by neointima prior to TAVR.
- Chronic mechanical stress between the TAVR device and the mitral-aortic intervalvular fibrosa is hypothesized to cause progressive damage.
Implications:
- Delayed mitral valve dehiscence and subsequent hemolysis can occur long after TAVR.
- Thorough preprocedural imaging is essential to identify potential anatomical risks.
- Prolonged postprocedural surveillance is necessary for patients with pre-existing mitral prostheses undergoing TAVR.
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