title: Direct Flow valve-in-valve implantation in a degenerated mitral bioprosthesis.
abstract: OBJECTIVE
  Mitral valve reoperations due to failing bioprostheses, in patients affected by multiple comorbidities, are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these patients at high risk for surgery.
  
  
  RESULTS
  We describe a case of Direct Flow 25 mm transcatheter valve implantation as valve-in-valve in a degenerated mitral bioprosthesis through a transapical approach in a 63-year-old man affected by dilated cardiomyopathy. The patient was affected by Carpentier-Edwards 29 mm severe regurgitation. The 25 mm Direct Flow bioprosthesis was advanced through the mitral bioprosthesis into the left atrium and then positioned using the three independent positioning wires. Transoesophageal echocardiography evidenced normal Direct Flow function with no paravalvular regurgitation and a low transmitral gradient of 4 mmHg.
  
  
  CONCLUSIONS
  Our successful experience, characterised by a Heart Team approach and multidisciplinary patient care, demonstrated the technical feasibility and procedural safety of Direct Flow valve-in-valve mitral implantation.
authors.affiliation: Cardiology & Cardiac Surgery Department "A. De Gasperis", Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Alberto
authors.initials: A
authors.lastname: Barosi
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.forename: Francesco
authors.initials: F
authors.lastname: Soriano
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
authors.forename: Elisa
authors.initials: E
authors.lastname: Montrasio
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Gagliardone
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
mesh_terms: D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome