Eng, Marvin H

Kang, Guson

So, Chak-Yu

English

Henry Ford Health System Scholarly Commons

Henry Ford Health Henry Ford Health Scholarly Commons Cardiology Meeting Abstracts Cardiology/Cardiovascular Research 4-2021 Chase the Leak - A Case of Valve-in-Ring with Mitral PVL Closure Chak-Yu So Guson Kang Marvin H. Eng Henry Ford Health, meng1@hfhs.org Follow this and additional works at: https://scholarlycommons.henryford.com/cardiology_mtgabstracts Recommended Citation So CY, Kang G, and Eng M. Chase the Leak - A Case of Valve-in-Ring with Mitral PVL Closure. J Am Coll Cardiol 2021; 77(14):S247-S248. This Conference Proceeding is brought to you for free and open access by the Cardiology/Cardiovascular Research at Henry Ford Health Scholarly Commons. It has been accepted for inclusion in Cardiology Meeting Abstracts by an authorized administrator of Henry Ford Health Scholarly Commons. Conclusions. This case report shows that the technical challenges forTAVR with balloon expandable prosthesis in patients with Starr-Edwards valve mitral prosthesis can be overcome with a compre-hensive evaluation of the patient prior to the procedure.STRUCTURAL HEART DISEASE - VALVULARINTERVENTION: MITRAL OR TRICUSPID (TCTAP C-113)TCTAP C-113Chase the Leak - A Case of Valve-in-Ring with Mitral PVLClosureChak Yu So,1 Guson Kang,2 Marvin Eng31Prince of Wales Hospital, Hong Kong, China; 2VAPAHCS & StanfordHealth Care, USA; 3Henry Ford Hospital, USACLINICAL INFORMATIONPatient Initials or Identifier Number. CTRelevant Clinical History and Physical Exam. CT is a 75-year-old jehovah’switness with a history of Ca breast, chemotherapy induced cardio-myopathy, atrial fibrillation and severe mitral regurgitation with priormitral valve annuloplasty using a 30mm St Jude Saddle Ring. Shepresented with 6 months of worsening shortness of breath.Relevant Test Results Prior to Catheterization. Her echocardiogram foundrecurrent severe mitral regurgitation due to leaflet tethering and apartial mitral ring dissidence, and LVEF 30%.Relevant Catheterization Findings. Heart team deems her inoperablecandidate due to frailty and status of jehowah’s witness refusing anyblood product transfusion. Mitral valve edge to edge repair wasthought to be challenging due to presence of mitral ring, restrictedposterior leaflet and shadowing by the ring in imaging the posteriorleaflet during intra-procedural TEE. In view of these, heart team rec-ommended for transseptal transcatheter mitral valve replacement -valve in ring, with transcatheter ring dissidence repair.INTERVENTIONAL MANAGEMENTProcedural Step. Transseptal TMVR was performed using a 26mmSAPIEN 3 valve. Mitral paravalvular leak was repaired with 2 occluderdevices (VSD 8mm and ADO2 6/4 devices). Yet procedure wascomplicated with iatrogenic ring dehiscence over lateral trigon region,and one of the occluder device was found to interact with the newlyimplanted S3 valve leaflet leading to new valvular and paravalvularleak. We implanted a new S3 valve inside the newly implanted S3valve and eliminated the intra-valvular leak. Afterwards, we alsorepaired the new paravalvular leak with a ADO2 device. The valve wasstable in position and the leak reduced to trace-mild.J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 7 7 , N O . 1 4 , S U P P L S , 2 0 2 1 S247Downloaded for Anonymous User (n/a) at Henry Ford Hospital / Henry Ford Health System (CS North America) from ClinicalKey.com by Elsevier on May 26, 2021. For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.Conclusions. Learning points:1. TMVR with PVL Closure is feasible to tackle recurrent mitral regur-gitation post mitral ring annuloplasty with ring dehiscence.2. Obtaining access across the ring dehiscence before TMVR valve im-plantation is important to avoid wiring crossing into newly implantedvalve stent strut3. Valve in ring TMVR could result in ring dehiscence, commonly attrigone region4. Be ready to chase the leak in all VIR TMVRS248 J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 7 7 , N O . 1 4 , S U P P L S , 2 0 2 1Downloaded for Anonymous User (n/a) at Henry Ford Hospital / Henry Ford Health System (CS North America) from ClinicalKey.com by Elsevier on May 26, 2021. For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.

Chase the Leak - A Case of Valve-in-Ring with Mitral PVL Closure

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Chase the Leak - A Case of Valve-in-Ring with Mitral PVL Closure

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