TAVR in Rheumatic Aortic Stenosis With Mechanical Mitral Prosthesis: Case Series on Short Annulus-Prosthesis Distance

Patients with rheumatic aortic stenosis and prior mechanical mitral valve replacement present unique challenges for transcatheter aortic valve replacement, particularly when the aortomitral distance is short. This case series examines 4 such patients, focusing on procedural complexities, imaging strategies, and outcomes. Preprocedural multidetector computed tomography and intraprocedural transesophageal echocardiography were critical in assessing anatomical constraints and optimizing valve deployment. Key considerations included preventing mitral prosthesis interference, mitigating left ventricular outflow tract obstruction, and ensuring stable valve positioning. One patient experienced mitral leaflet impingement, necessitating transcatheter heart valve repositioning. Despite these challenges, no transcatheter heart valve embolization occurred, and all patients had favorable clinical outcomes. This study highlights the importance of individualized procedural strategies, careful valve selection, and advanced imaging techniques in successfully navigating transcatheter aortic valve replacement in this complex subset of patients.