Emergency transseptal transcatheter mitral valve-in-valve implantation.
OBJECTIVE
We report a case of emergency transcatheter heart valve implantation in a failing mitral bioprosthesis via a transseptal access complicated by the atrial migration of a prosthesis.


RESULTS
A 42-year-old woman was referred for stenotic failure of a mitral bioprosthesis. A transapical valve-in-valve implantation was initially planned. However, due to sudden haemodynamic deterioration, an emergency transseptal implantation via a femoral venous access was undertaken. Following cardiac arrest, the procedure was performed with extracorporeal membrane oxygenation (ECMO), and was complicated by the migration of a valve, which was left moving freely in the left atrium. A second valve was successfully implanted in the mitral bioprosthesis. Following initial clinical recovery, there was a sudden recurrence of heart failure due to entrapment of the migrated valve in the implanted valve in a "reverse position", which was dislodged percutaneously in an emergency procedure. The valve later migrated into the left atrial appendage. Immediate outcome was uneventful, but the patient suddenly died six months later.


CONCLUSIONS
Transseptal transcatheter mitral valve-in-valve implantation is feasible, even in an emergency setting with ECMO. Valve migration in the left atrium may occur and lead to late entrapment in a "reverse position", with significant haemodynamic consequences.
Department of Cardiology, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France.
Amir-Ali
AA
Fassa
Dominique
D
Himbert
Eric
E
Brochet
Soleiman
S
Alkhoder
Nawwar
N
Al-Attar
Pierre-Yves
PY
Brun
Michel
M
Wolff
Patrick
P
Nataf
Alec
A
Vahanian
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D004630:Emergencies; D017809:Fatal Outcome; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D011474:Prosthesis Design; D012307:Risk Factors