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MIGRATION OF THE PROSTHETIC MITRAL VALVE AFTER TRANSCATHETER MITRAL VALVE REPLACEMENT FOR SEVERE CALCIFIC MITRAL STENOSIS
2427 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making MIGRATION OF THE PROSTHETIC MITRAL VALVE AFTER TRANSCATHETER MITRAL VALVE REPLACEMENT FOR SEVERE CALCIFIC MITRAL STENOSIS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Interventional Cardiology, Acute and Stable Ischemic Heart Disease, and Vascular Medicine Abstract Category: Interventional Cardiology Presentation Number: 1300-375 Authors: Saurabh Sharma, Gregg Pressman, Christian Witzke, Albert Einstein Medical Center, Philadelphia, PA, USA
Background:Transcatheter Mitral Valve (MV) replacement is a less invasive alternative for patients deemed high risk for mitral valve surgery.
Case: A 52 years old male with severe mitral stenosis (MS), multiple comorbidities and multiple readmissions presented again with class IV heart failure symptoms. Transthoracic echo demonstrated severe MS with severe mitral annulus calcification (MAC) (Panel A).
Decision‐Making: The MV was deemed unsuitable for percutaneous balloon valvuloplasty due to severe MAC. Surgery was deemed high risk due to comorbidities and high STS score. Hence a transapical transcatheter mitral valve replacement procedure with 29 mm Edwards Sapien XT valve was performed. Post procedure the prosthetic MV was well seated (Panels B,C) with mild paravalvular leak at 10 o’clock (Panel D). Patient was discharged on day 5. 3 week later, he presented with shortness of breath. Transesophageal echo demonstrated migration of the MV prosthesis (Panel E). At this time, surgical intervention remained high risk; however was the most likely option. Surgical replacement of the MV with 27 mm pericardial valve was performed. Intraoperatively, the transcatheter Edwards Sapiens valve was seen dislodged in the left atrium (Panel F). By 11th postoperative day patient was discharged to a nursing home in a stable condition.
Conclusions: This case illustrates the difficult decision making process in management of MS with severe MAC; and prosthesis migration as a complication of transcatheter MV replacement.
FIT Clinical Decision Making MIGRATION OF THE PROSTHETIC MITRAL VALVE AFTER TRANSCATHETER MITRAL VALVE REPLACEMENT FOR SEVERE CALCIFIC MITRAL STENOSIS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Interventional Cardiology, Acute and Stable Ischemic Heart Disease, and Vascular Medicine Abstract Category: Interventional Cardiology Presentation Number: 1300-375 Authors: Saurabh Sharma, Gregg Pressman, Christian Witzke, Albert Einstein Medical Center, Philadelphia, PA, USA
Background:Transcatheter Mitral Valve (MV) replacement is a less invasive alternative for patients deemed high risk for mitral valve surgery.
Case: A 52 years old male with severe mitral stenosis (MS), multiple comorbidities and multiple readmissions presented again with class IV heart failure symptoms. Transthoracic echo demonstrated severe MS with severe mitral annulus calcification (MAC) (Panel A).
Decision‐Making: The MV was deemed unsuitable for percutaneous balloon valvuloplasty due to severe MAC. Surgery was deemed high risk due to comorbidities and high STS score. Hence a transapical transcatheter mitral valve replacement procedure with 29 mm Edwards Sapien XT valve was performed. Post procedure the prosthetic MV was well seated (Panels B,C) with mild paravalvular leak at 10 o’clock (Panel D). Patient was discharged on day 5. 3 week later, he presented with shortness of breath. Transesophageal echo demonstrated migration of the MV prosthesis (Panel E). At this time, surgical intervention remained high risk; however was the most likely option. Surgical replacement of the MV with 27 mm pericardial valve was performed. Intraoperatively, the transcatheter Edwards Sapiens valve was seen dislodged in the left atrium (Panel F). By 11th postoperative day patient was discharged to a nursing home in a stable condition.
Conclusions: This case illustrates the difficult decision making process in management of MS with severe MAC; and prosthesis migration as a complication of transcatheter MV replacement.