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Percutaneous Trans Catheter Mitral Valve-in-valve Implantation In Surgical Bio-prosthetic Valve Fracture For Optimising Hemodynamics
Attaullah Khan Niazi1, mohammed sharif nassery2.
1Shalamar Hospital Lahore, Lahore, Pakistan, 2Punjab institute of Cardiokogy, Lahore, Pakistan.

BACKGROUND: Transcatheter valve-in-valve implantation is an attractive option for treating surgicalprosthetic valve dysfunction
- High residual gradient remains a concern, especially for surgical valves with a small true internal dimensionLimited data exists for bio-prosthetic valve fracture in the mitral position
- Present case highlights surgical bioprosthetic valve fracture done to allow full expansion of the
transcatheter valve and optimize hemodynamics METHODS:
Presenting complaints: breathlessness on exertion on walking 1 fight of stairs or greater since 2017. Past medical details: - Diabetic and hypertensive , 2008,2013 NSTEMI PCI mid LAD - 2017: worsening of dyspnoea , Moderate mitral regurgitation with mild left ventricular systolic dysfunction., Progressive CAD, CABG (SVG to LAD, OM ) with MVR ( Bioprosthetic valve SJM EPIC 25; Tammerfors)2017 Investigation NT Pro BNP- >3000 pg/ml Mean PA pressure- 40mmHg (Cath) ECHO - prosthetic valve dysfunction , Bioprosthetic valve thickened & restricted in Transmitral mean gdt-11mmHg, mitral regurgitation CT parameter Procedure - Transcatheter mitral valve in valve implantation Transfemoral access
General anesthesia, TEE guidance
RESULTS: 6 months followup Significant improvement of his symptoms Mean mitral gradient- 4mmHg
No valve thrombosis CONCLUSIONS:
This case highlights successful fracture of a surgical bio-prosthetic valve to improve hemodynamics during trans catheter mitral valve- in-valve implantation


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