Treating a Childhood Cancer Survivor With Severe Aortic and Mitral Insufficiency Using TAVR and TMVR

Adult survivors of childhood cancer experience an increased risk of cardiovascular disease. Surgical therapy is often high risk, particularly in survivors with history of mediastinal radiation. Transcatheter valve intervention for these patients is an evolving field.

A 58-year-old woman with history of Hodgkin lymphoma s/p mediastinal radiation therapy and recent coronary artery bypass grafting presented with recurrent congestive heart failure. Echocardiography revealed moderate-severe aortic insufficiency, severe mitral regurgitation/mild mitral stenosis, and severe tricuspid regurgitation. After receiving transcatheter aortic valve replacement requiring extracorporeal membrane oxygenation support, she remained balloon pump dependent. Given her mild mitral stenosis, transcatheter edge-to-edge repair was not feasible, and she was treated with transcatheter mitral valve replacement on an emergency use basis. She was ultimately discharged home.

Multivalvular disease in survivors of childhood cancer present anatomical challenges and transcatheter valve therapies will play an increasing role in these patients.

Survivors of childhood cancer can develop severe coronary artery and complex valvular disease. Some of these patients, particularly those with history of chest radiation, will have a hostile mediastinum with elevated surgical risk; transcatheter interventions could be an alternative therapy. For patients with mixed mitral valve disease, Transcatheter mitral valve replacement is feasible but is limited to research devices until one or more technologies are commercially available.