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Transcatheter Mitral Valve-in-Valve-in-Valve Implantation: Implications of complex interventional technique and 3D echocardiography for valve-in-valve Paravalvular Leak
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  • Sankalp Sehgal,
  • Pritha Subramanyam,
  • Monica Ahluwalia,
  • Ashish Rastogi,
  • Geoffrey Bergman
Sankalp Sehgal
Cornell University Joan and Sanford I Weill Medical College
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Pritha Subramanyam
Weill Cornell Medical College
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Monica Ahluwalia
Brigham and Women's Hospital Carl J and Ruth Shapiro Cardiovascular Center
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Ashish Rastogi
Weill Cornell Medical College
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Geoffrey Bergman
Weill Cornell Medical College
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Paravalvular leak (PVL) after mitral valve replacement is the most common type of nonstructural prosthetic valve dysfunction. While most patients with only mild-moderate PVL are asymptomatic, those with severe PVL can present with heart failure and hemolysis, leading to significant morbidity and mortality. Surgical correction has remained the gold standard therapy for symptomatic PVL; however, for high surgical risk patients, percutaneous approaches have emerged as an alternative management. With the emergence of transcatheter mitral valve-in-valve techniques for failed bioprosthesis and rings, valve-in-valve PVL is being encountered more frequently and is identified as a challenging entity. We present a case of a symptomatic patient with a moderate – severe valve-in-valve PVL after two mitral valve replacements who then underwent a transcatheter mitral valve-in-valve-in-valve implantation with a 29mm Edwards® SAPIEN3 valve via transseptal approach. This unique case highlights the complexity of this clinical entity and recognizes three-dimensional transesophageal echocardiography as a tool to guide valve-in-valve PVL closures.

Peer review status:IN REVISION

23 Jul 2020Submitted to Echocardiography
23 Jul 2020Assigned to Editor
23 Jul 2020Submission Checks Completed
23 Jul 2020Reviewer(s) Assigned
13 Sep 2020Review(s) Completed, Editorial Evaluation Pending
13 Sep 2020Editorial Decision: Revise Major