IJCM  Vol.3 No.7 , December 2012
Successful Tavi in Patients with Previous Mitral Valve Replacement
ABSTRACT
Background: Transcatheter aortic valve implantation (TAVI) is a new method for patients with severe aortic stenosis at high surgical risk, such as previous cardiac surgery. The presence of mechanical mitral prosthesis might complicate TAVI because of possible interference between both prostheses. Some reports have already demonstrated the feasibility of TAVI in such patients. Case Reports: We report 2 patients with severe symptomatic aortic stenosis who had prior mitral valve replacement that successfully underwent TAVI with Edwards Sapien and CoreValve aortic prosthesis, re- spectively. Computed tomographic angiography (CTA) was useful for the assessment of the distance between both aor- tic and mitral prosthesis annuli. Transesophageal echocardiography was crucial for precise positioning of TAV. There were no special technical tips besides precise positioning of the valve prosthesis. In case of Core Valve the goal was the positioning at “zero point” and in case of Edwards Sapien valve a “half-on-half” position according to natural aortic valve. We observed no deformation or dysfunction of aortic and mitral prosthesis in any of the patients. Balloon valvu- loplasty prior to implantation helps to observe the mutual effect of the new aortic valve and pre-existent mitral prosthe- sis. Conclusions: We conclude that TAVI can be safely and successfully performed in patients with mechanical mitral prosthesis carefully considering the altered anatomical conditions. Skillfulness and TAVI experience of the operators should not be neglected.

Cite this paper
M. Bunc, J. Ambrozic, S. Music, N. Lakic, P. Berden and R. Zbacnik, "Successful Tavi in Patients with Previous Mitral Valve Replacement," International Journal of Clinical Medicine, Vol. 3 No. 7, 2012, pp. 603-606. doi: 10.4236/ijcm.2012.37109.
References
[1]   J. G. Webb, L. Altwegg, R. H. Boone, et al., “Transcatheter Aortic Valve Implantation: Impact on Clinical and Valve-Related Outcomes,” Circulation, Vol. 119, 2009, pp. 3009-3016. doi:10.1161/CIRCULATIONAHA.108.837807

[2]   “Placement of AoRTic TranscathetER Valve (PARTNER) trial,” NCT00530894, 2012. http://clinicaltrials.gov/ct2/show/NCT00530894

[3]   J. Rodés-Cabau, E. Dumont, S. Miró, et al., “Apical Aortic Valve Implantation in a Patient with a Mechanical Valve Prosthesis in Mitral Position,” Circulation: Cardiovascular Interventions, Vol. 1, 2008, p. 233. doi:10.1161/CIRCINTERVENTIONS.108.813592

[4]   N. Dumonteil, B. Marcheix, P. Berthoumieu, et al., “Transfemoral Aortic Valve Implantation with Pre-Existent Mechanical Mitral Prosthesis: Evidence of Feasibility,” JACC: Cardiovascular Interventions, Vol. 2, No. 9, 2009, pp. 897-898. doi:10.1016/j.jcin.2009.05.023

[5]   G. Bruschi, F. De Marco, J. Oreglia, et al., “Percutaneous Implantation of CoreValve Aortic Prostheses in Patients with a Mechanical Mitral Valve,” Annals of Thoracic Surgery, Vol. 88, No. 5, 2009, pp. 50-52. doi:10.1016/j.athoracsur.2009.07.028

[6]   V. T. Chao, P. T. Chiam and S. Y. Tan, “Transcatheter Aortic Valve Implantation with Preexisting Mechanical Mitral Prosthesis—Use of CT Angiography,” Journal of Invasive Cardiology, Vol. 22, No. 7, 2010, pp. 339-340.

[7]   M. Scherner, J. T. Strauch, P. L. Haldenwang, F. Baer and T. Wahlers, “Successful Transapical Aortic Valve Replacement in a Patient with Previous Mechanical Mitral Valve Replacement,” Annals of Thoracic Surgery, Vol. 88, No. 5, 2009, pp. 1662-1663. doi:10.1016/j.athoracsur.2009.04.078

[8]   C. J. Beller, R. Bekeredjian, U. Krumsdorf, et al., “Transcatheter Aortic Valve Implantation after Previous Mechanical Mitral Valve Replacement: Expanding Indications?” Heart Surgery Forum, Vol. 14, No. 3, 2011, pp. 166-170. doi:10.1532/HSF98.20101148

 
 
Top