title: Transcatheter Mitral Valve-in-Ring for Progressive Mitral Stenosis after Prior Repair with Annuloplasty: A Novel Balloon Sizing Technique.
abstract: An 83-year-old man with a previous mitral valve repair using a semi-rigid annuloplasty ring was found to have severe mitral stenosis. A transcatheter approach for mitral valve-in-ring replacement was selected due to the patient's high surgical risk. Pre-procedural computed tomography scans for transcatheter valve size selection were inconsistent with previously published recommendations. To determine the appropriate valve size, a 25 mm compliant balloon was inflated intraoperatively within the stenotic mitral ring, but yielded no resistance to movement and no 'waist'. Thus, a 29 mm balloon-expandable prosthetic valve was selected and deployed with no paravalvular leak. This novel balloon sizing technique helped lead to a successful outcome in this case. Video 1: Angiographic video displaying mitral valve-in-ring balloon sizing technique. The 25 mm compliant balloon was inflated within a stenotic mitral ring to determine which prosthetic transcatheter valve size was appropriate. As shown, this technique yielded no 'waist' and no resistance to movement, suggesting that a 29 mm valve was necessary.
authors.affiliation: School of Medicine, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Sola
authors.affiliation: Division of Cardiothoracic Surgery, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Caranasos
authors.affiliation: Division of Cardiology, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yeung
authors.affiliation: Division of Cardiology, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Cassandra J
authors.initials: CJ
authors.lastname: Ramm
authors.affiliation: Division of Cardiothoracic Surgery, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Sell
authors.affiliation: Division of Cardiology, The University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Vavalle
mesh_terms: D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000295:instrumentation*; D018450:Disease Progression; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome