Trans-catheter Aortic Valve Implantation in Patients with Previous Mitral Valve Replacement: A Case Series
Received Date: Dec 13, 2017 / Accepted Date: Dec 20, 2017 / Published Date: Dec 26, 2017
Introduction: Transcatheter aortic valve implantation is a routine clinical method for patients with severe aortic stenosis at high surgical risk, such as previous cardiac surgery. The presence of mechanical mitral prosthesis might complicate trans-catheter aortic valve implantation because of possible interference between both prostheses. Some clinical reports have already demonstrated the feasibility of trans-catheter aortic valve implantation in such patients.
Methods and results: We report 4 patients with severe symptomatic aortic stenosis who had prior mitral valve replacement that successfully underwent trans-catheter aortic valve implantation with Sapien XT (Edwards Lifesiences, Irvine, USA) and CoreValve (Medtronic, Irvine, USA) aortic prosthesis. Multi-slice computed tomographic angiography was used for the assessment of the distance between both aortic and mitral prosthesis annuli. Trans-esophageal echocardiography was introduced for precise positioning of trans-catheter aortic valve. There were no special technical tips besides precise positioning and slow opening of the valve prosthesis. In case of CoreValve the goal was the positioning close to “zero point” and in case of Edwards Sapien valve higher as a “halfon- half” position according to natural aortic valve. We observed no deformation or dysfunction of aortic and mitral prosthesis in any of the patients. Balloon aortic valvuloplasty prior to implantation is not mandatory; however it helps to observe the mutual effect of the new aortic valve and pre-existent mitral prosthesis.
Conclusions: We conclude that trans-catheter aortic valve implantation can be safely and successfully performed in patients with mechanical mitral prosthesis. It is important to carefully evaluate the anatomical conditions with trans-esophageal echocardiography and computed tomographic angiography. Skillfulness and experience of the operators should not be neglected.
Keywords: Aortic valve stenosis; Trans-catheter aortic valve replacement; Mitral valve replacement; Aortic prosthesis; Mitral prosthesis
Citation: Škafar M, Zbacnik R, Ambrožic J, Lakic N, Terseglav S, et al. (2017) Trans-catheter Aortic Valve Implantation in Patients with Previous Mitral Valve Replacement: A Case Series. J Clin Exp Cardiolog 8: 563. Doi: 10.4172/2155-9880.1000563
Copyright: ©2017 Škafar M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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