Related Experiment Video
Updated: Aug 5, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter Mitral Valve Replacement in Failed Mitral Bioprosthesis: Case Report
Veselin Valkov1,2, Nikolay Dragnev1,3, Josef Bis4
1First Cardiology Department, UMHAT "St. Marina", Varna, Bulgaria.
Case Reports in Cardiology
|August 4, 2026
Summary
Transcatheter valve-in-valve mitral valve replacement (ViV TMVR) successfully treated severe mitral stenosis in a high-risk patient. Septal dilation during ViV TMVR can cause hemodynamic compromise, requiring rapid intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Degeneration of surgical mitral bioprostheses can lead to severe mitral stenosis.
- Transcatheter valve-in-valve mitral valve replacement (ViV TMVR) is an option for high-risk patients.
- Prosthetic mitral stenosis presents unique management challenges.
Purpose of the Study:
- To present a case of successful transseptal ViV TMVR for degenerated bioprosthesis with severe mitral stenosis.
- To highlight the potential complication of iatrogenic interatrial shunt during ViV TMVR.
- To demonstrate management of acute hemodynamic compromise during the procedure.
Main Methods:
- A 75-year-old woman with a failed bioprosthesis and severe mitral stenosis underwent transseptal ViV TMVR.
- ECG-gated computed tomography was used for procedural planning.
- Rescue balloon dilation and SAPIEN 3 valve implantation were performed due to hemodynamic compromise.
Main Results:
- Successful implantation of a 26-mm SAPIEN 3 valve restored transmitral flow.
- Mean transmitral gradient decreased from 13 mmHg to 3.5 mmHg.
- The patient remained asymptomatic at 2-year follow-up with stable valve function.
Conclusions:
- Transseptal ViV TMVR is feasible for severe prosthetic mitral stenosis in high-risk patients.
- Septal dilation can cause significant left-to-right shunting, leading to hemodynamic instability.
- Prompt intervention, including balloon dilation, is crucial for managing acute complications during ViV TMVR.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
01:25Mitral Regurgitation III: Medical Management
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
01:22Mitral Valve Prolapse II: Assessment and Management
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
01:27Mitral Valve Prolapse I: Introduction
IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
01:20Mitral Regurgitation I: Introduction
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
01:19Mitral Valve Prolapse III: Nursing Management
The nursing management of Mitral Valve Prolapse, or MVP, centers around patient education, symptom monitoring, and lifestyle modifications.Patient Education on MVP Diagnosis and Heredity: Nurses should provide comprehensive education about MVP, a condition where the mitral valve does not close appropriately during heartbeats. This education often includes the condition's pathophysiology, symptoms, and potential complications, like arrhythmias or mitral regurgitation. Though not fully...