title: Emergency transthoracic transapical mitral valve-in-valve implantation.
abstract: OBJECTIVE
  The valve-in-valve (VIV) technique is an emerging therapeutic option for patients with failure of previously implanted xenografts. We describe a balloon-expandable transthoracic transapical mitral VIV implantation in an emergency setting in a 69-year-old woman with dysfunction of the mitral bioprosthesis.
  
  
  METHODS
  Left ventricular apical access was applied. After balloon valvuloplasty, a 26-mm Edwards-Sapien transcatheter valve (Edwards Lifesciences LLC, Irvine, CA, USA) was deployed within the mitral xenograft, using rapid ventricular pacing.
  
  
  RESULTS
  The transcatheter valve functioned properly postoperatively and three-dimensional echocardiography carried out 1 month later showed a well-functioning VIV prosthesis and no mitral stenosis (mitral valve area 3 cm(2) , mean gradient 3 mmHg).
  
  
  CONCLUSIONS
  In this patient, VIV implantation was found to be a safe alternative to an emergent valve replacement. It might represent a suitable option to conventional procedures even among lower risk patients.
authors.affiliation: Department of Cardiac Surgery, Academic Hospital, Maastricht, The Netherlands.
authors.forename: Leen A F M
authors.initials: LA
authors.lastname: van Garsse
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Vincent
authors.initials: V
authors.lastname: van Ommen
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
mesh_terms: D000368:Aged; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D004452:Echocardiography; D004638:Emergency Treatment / Q000295:instrumentation / Q000379:methods; D005260:Female; D005263:Femoral Artery; D006085:Graft Survival; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006352:Heart Ventricles; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D008946:Mitral Valve Stenosis / Q000473:pathology / Q000628:therapy*