JACC. Case reports · 2026
Transseptal Mitral Valve-in-Valve Implantation Using an Arteriovenous Loop.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Li Yan-Jie, Ma Lan, Hao Zi-Yong, Pan Xin
Аннотация
BACKGROUND: Transseptal mitral valve-in-valve (ViV) implantation is an established therapy for failed surgical bioprostheses. However, massive biatrial enlargement can preclude delivery, leading to procedural failure.
CASE SUMMARY: A 75-year-old woman presented with heart failure after surgical mitral bioprosthesis implantation. Echocardiography revealed severe mitral bioprosthetic failure and massive biatrial enlargement. Computed tomography angiography showed a septal-annular angle of 106°. During the procedure, the stiff wire and the delivery system repeatedly prolapsed into the giant atrium. A full-body rail was created by snaring the guidewire from the femoral artery, providing adequate support. Then a 23-mm SAPIEN 3 valve was successfully deployed. Postprocedural mean gradient decreased to 4 mm Hg with mild paravalvular leak. The patient recovered uneventfully with significant functional improvement.
DISCUSSION: The full-body rail technique is a critical bailout strategy for mitral ViV in patients with massive atria, enabling coaxial alignment and safe delivery.
TAKE-HOME MESSAGES: Massive biatrial enlargement and a horizontal septal-annular angle (>100°) can preclude standard delivery during mitral ViV implantation. The step-by-step creation of a full-body (arteriovenous) rail is a rescue technique to stabilize the delivery system.
CASE SUMMARY: A 75-year-old woman presented with heart failure after surgical mitral bioprosthesis implantation. Echocardiography revealed severe mitral bioprosthetic failure and massive biatrial enlargement. Computed tomography angiography showed a septal-annular angle of 106°. During the procedure, the stiff wire and the delivery system repeatedly prolapsed into the giant atrium. A full-body rail was created by snaring the guidewire from the femoral artery, providing adequate support. Then a 23-mm SAPIEN 3 valve was successfully deployed. Postprocedural mean gradient decreased to 4 mm Hg with mild paravalvular leak. The patient recovered uneventfully with significant functional improvement.
DISCUSSION: The full-body rail technique is a critical bailout strategy for mitral ViV in patients with massive atria, enabling coaxial alignment and safe delivery.
TAKE-HOME MESSAGES: Massive biatrial enlargement and a horizontal septal-annular angle (>100°) can preclude standard delivery during mitral ViV implantation. The step-by-step creation of a full-body (arteriovenous) rail is a rescue technique to stabilize the delivery system.