Work

TAVI in Patient With Severe Aortic Regurgitation and Previous Mechanical Mitral and Tricuspid Valve Prostheses

Year: 2025

Type: article

Abstract: BACKGROUND: Transcatheter aortic valve implantation is technically challenging in patients with predominant aortic regurgitation and preexisting mitral prosthetic heart valve. CASE SUMMARY: To the best of our knowledge, this is the first reported case in which transcatheter aortic valve implantation was successfully performed for predominant severe aortic regurgitation with a history of 3 prior sternotomies: successively for mitral valve replacement with a Starr-Edwards valve, tricuspid valve repair, and subsequently tricuspid valve replacement. DISCUSSION: This patient had large aortic annulus dimensions. Noticing predominant aortic regurgitation and mild valvular calcium, we were aiming at 15% to 20% oversizing of the transcatheter valve, which was achievable by overfilling the largest balloon-expandable valve. Having an incomplete understanding of potential aortomitral interaction based on computed tomography and echocardiography, we inflated a balloon at the aortic valve, which revealed significant interaction, leading us to use a self-expanding valve that had limited oversizing. TAKE-HOME MESSAGE: Identifying the aortomitral interaction in such cases can potentially avoid transcatheter aortic valve embolization.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106291

Authors: Amit Gupta, Ammar Albayati, Brooke Keeble, Allan Davies, Rohan Bhagwandeen, Andrew J. Boyle

Institutions: John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle Australia

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850