January 2013 At 10 years old, a female patient with rheumatic heart disease presents with severe shortness of breath. She undergoes bioprosthetic mitral valve replacement due to severe combined mitral stenosis and regurgitation and does well for the next two years.
February 2015 At 12 years old, patient exhibits shortness of breath (class II) that progresses to class III in the third postoperative year.
April 2016 At 13-year-old, she was presented with severe SOB and admitted to the hospital.
A transthoracic echocardiography shows a degenerated bioprosthetic mitral valve and severely dilated right ventricle with significantly depressed function. Severe mitral stenosis was observed (mean pressure gradient of 18 mm Hg).
The heart team discussed the case and opted not to perform surgery. The team recommended a transcatheter mitral valve replacement.
The transcatheter mitral valve replacement was successfully completed. The patient’s mean pressure gradient with the new valve was 5 mm Hg. After extubation, the patient was moved to the intensive care unit and then discharged after 2 days.
Follow up after 30 months At the patient’s 30-month post-procedure follow-up, she reported regular daily activity with no shortness of breath. A follow-up transthoracic echocardiography revealed that the right ventricle had reduced in size and demonstrated normal function. The systolic pulmonary artery pressure reduced to 33 mm Hg, the mean pressure gradient of the left ventricular outflow tract was 10 mm Hg, and the mitral valve mean pressure gradient was 6 mm Hg.