Hemolysis Due To Stuck Valve Leaflet After Transcatheter Valve-in-valve Mitral Procedure
Christoph Krapf, Ulvi C. Özpeker, Ludwig Müller, Julia Dumfarth, Juliane Kilo, Michael Grimm, Nikolaos Bonaros
Medical University Innsbruck, Innsbruck, Austria
We present a case of an 81-year-old woman with a symptomatic severe mitral valve regurgitation combined with a grade II mitral valve stenosis due to a biological prosthesis degeneration - size 29mm. The patient underwent a double valve replacement 16 years ago and the aortic bioprosthesis was competent. Due to age and high operative risk the decision for transapical mitral valve-in-valve intervention was made. A 29mm balloon- expandable bioprosthesis was implanted. After initial expansion, the valve showed an eccentric transvalvular leakage due to underexpansion of the anterior part of the valve probably due to the existence of the aortic bioprosthesis. A secondary balloon-inflation with +4ml was performed. After that the patient left the operation theatre with a good functioning valve with minimal paravalvular leakage. The days after the patient showed up with anemia and needed repeated blood transfusions. She also suffered from acute renal impairment. In a control echocardiography the eccentric insufficiency-jet reappeared. This was associated to a stuck leaflet of the mitral prosthesis next to the bioprosthetic aortic valve. The patient underwent reoperation for sustained hemolysis. The underexpansion of the mitral valve associated with the presence of the aortic bioprosthesis was confirmed. The operation - a mitral valve replacement - was successful and the patient was discharged after six weeks of hospitalization. Mitral valve-in-valve at the presence of an aortic valve prosthesis can potentially be associated with valve underexpansion which may lead to valve dysfunction.
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