Transseptal Mitral Valve-in-Valve Implantation Via a Residual Iatrogenic ASD.

BACKGROUND

Degenerated surgical mitral bioprostheses may require reintervention, and transcatheter mitral valve-in-valve implantation has emerged as a less invasive alternative. Residual iatrogenic atrial septal defects (ASDs) may complicate hemodynamics, but they can also be incorporated into the procedural strategy.

CASE SUMMARY: A 58-year-old woman with a prior mitral bioprosthesis presented with advanced heart failure, prosthetic stenosis, pulmonary hypertension, and a residual iatrogenic ASD with left-to-right shunting. The ASD was used as the transseptal access route owing to favorable anatomical alignment. Preprocedural computed tomography showed a predicted neo-left ventricular outflow tract of 194.4 mm2. A 27-mm balloon-expandable valve was implanted, followed by ASD closure using a 32-mm occluder. The procedure improved valve hemodynamics and reduced central venous pressure from 26.5 to 9.4 mm Hg, with marked symptomatic improvement.

TAKE-HOME MESSAGE: A residual iatrogenic ASD can be used for mitral valve-in-valve access and closed in the same procedure in selected patients.