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Transseptal Access Through Prior Atrial Septal Occluder Device for TMVR for Prosthetic Mitral Valve Degeneration
Tiberio M Frisoli1, Muhammad Ahmad Qureshi2, Gennaro Giustino1
1Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA.
Background:
Transseptal access is critical for transcatheter mitral valve replacement (TMVR), but prior septal occlusion can complicate reinterventions.
Case Summary:
A 62-year-old woman with dyspnea and severe mitral stenosis of a degenerated M3 bioprosthetic valve underwent valve-in-valve TMVR with access achieved through a previously implanted 30-mm Cardioform Septal Occluder using an electrocauterized wire and Brockenbrough needle, followed by balloon dilatations. A 29-mm SAPIEN 3 valve was implanted, reducing the mitral gradient from 19 to 2 mm Hg. A residual left-to-right shunt was left untreated. The patient was discharged the next day without complications.
Discussion:
TMVR with a balloon-expandable TAVR platform can be performed safely and effectively through a Cardioform Septal Occluder and is facilitated by predilatation of the Cardioform Septal Occluder with a large balloon.
Take-Home Message:
Transseptal access through a Cardioform Septal Occluder is feasible for valve-in-valve TMVR. Awareness of strategies to manage prior interatrial septum closures is crucial as repeat mitral interventions become more common.
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