Figure legends
Figure 1. A: Degenerated calcific bioprosthetic mitral valve, with
aorta-mitral valve angle of 63°. B: Mean pressure gradient of mitral
valve is 18 mm Hg. C: Estimated systolic pulmonary artery pressure from
the tricuspid regurgitation jet is 66 mm Hg. D: Transoesophageal
echocardiography 2D shows degenerated bioprosthesis. E: 3D zoom from the
left atrium (diastolic frame) shows mitral valve not opening. F: 3D zoom
from the left ventricle shows thickened and calcified mitral valve.
Figure 2. A: Transseptal wire passing the degenerated mitral valve. B:
Balloon dilation (14-mm) of interatrial septum. C: 3D balloon dilation
of the bioprosthetic mitral valve. D: Balloon dilation of degenerated
mosaic bioprosthetic mitral valve. E: Snaring of the wire from the left
ventricle to the aorta. F: Deployment of the 23-mm Edwards SAPIEN 3
valve.
Figure 3. A: 3D deployment of 23-mm Edwards SAPIEN 3 valve. B:
Fluoroscopy of deployed valve. C: Mean pressure gradient of
valve-in-valve is 5 mm Hg. D: 2D colour image of deployed valve. E: 3D
image of deployed valve in diastole showing valve opening well. F:
Vascular plug closing the right ventricle apical puncture.
Figure 4. A: Apical, four-chamber view before mitral valve-in-valve with
dilated right ventricle. B: Apical, 4-chamber view at 30-month follow-up
showing smaller right ventricle. C: Estimated systolic pulmonary artery
pressure at 30-month follow-up is 33 mm Hg. D: Mean pressure gradient at
left ventricular outflow tract is 10 mm Hg, indicating no obstruction.
E: Mean pressure gradient of mitral valve-in-valve at 30-month follow-up
is 6 mm Hg.