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Updated: Jan 10, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transseptal Transcatheter Balloon Expandable Valve-in-Valve-in-Ring Implantation in Mitral Position
Johannes Wagner1, Andrejs Isajevs1, Renate Rauscher2
1Department of Cardiology, Angiology and Intensive Care Medicine, Cardiovascular Center Hersfeld-Rotenburg, Rotenburg an der Fulda, Germany.
Background:
The durability of transcatheter mitral valve replacement (TMVR) using the Edwards Sapien valve in a mitral ring remains uncertain. This report details a complex transseptal valve-in-valve-in-ring procedure and discusses long-term outcomes.
Case Summary:
A 73-year-old man, with a history of coronary bypass surgery and mitral valve reconstruction, underwent valve-in-ring implantation with an Edwards Sapien 3 26-mm prosthesis 7 years ago. Now he presented with progressive dyspnea (NYHA functional class III) due to severe prosthetic valve degeneration. A transseptal valve-in-valve intervention was performed using an Edwards Sapien 3 Ultra Resilia 26-mm valve inside the degenerated Sapien 3 26-mm valve within a 30-mm Physio ring.
Discussion:
Procedural challenges of valve-in-valve-in-ring interventions and their impact on TMVR longevity are reviewed, highlighting imaging guidance, transseptal puncture, and valve durability as key factors for long-term outcomes.
Take-Home Messages:
Transseptal valve-in-valve-in-ring implantation provides an alternative strategy for structural mitral valve deterioration. Long-term durability of TMVR requires continued assessment through dedicated registries and follow-up studies.
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