title: Transcatheter Valve-in-Valve Implantation in a Degenerated Mitral Bioprosthesis Using a Trans-Septal Anterograde Approach and 3-D Transesophageal Echocardiography Guidance.
abstract: Degenerated and dysfunctional prosthetic valves are usually replaced surgically. However, repeated cardiac surgery can cause prohibitive risk, especially in patients with many associated co-morbidities. Transcatheter valve-in-valve implantation (TVIV) is a novel, technically very challenging, but less invasive alternative treatment for patients with unacceptably high surgical risk of degenerated prosthetic valves. The method is attractive because it takes advantage of the presence of the degenerated prosthesis, which serves as an anchoring zone. Here, the case is presented of TVIV in an 82-year-old female with significant stenosis of a biological mitral prosthesis. In 2011, Himbert et al. were the first to successfully insert a transcatheter heart valve in the mitral ring using a transfemoral approach. To date, only a small case series has been reported on the effectiveness of TVIV using a transfemoral venous access and a trans-septal anterograde approach. The present patient was the first in which TVIV was performed in Poland and Eastern Europe.
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw.
authors.forename: Piotr N
authors.initials: PN
authors.lastname: Rudzinski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Dzielinska
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw.
authors.forename: Marek
authors.initials: M
authors.lastname: Konka
authors.affiliation: Department of Cardiology, 4th Military Clinical Hospital, Wroclaw, Poland.
authors.forename: Kulej-Lyko
authors.initials: KL
authors.lastname: Katarzyna
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw.
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
mesh_terms: D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008943:Mitral Valve; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome