Author + information
- Received February 11, 2015
- Accepted March 2, 2015
- Published online August 24, 2015.
- ∗Sarasota Memorial Hospital, Sarasota, Florida
- †Hartford Hospital, University of Connecticut, Hartford, Connecticut
- ‡Mayo Clinic, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Atiq Rehman, 1 Brace Road, Suite B, Cherry Hill, New Jersey 08034.
A 72-year-old man with a history of mitral valve (MV) repair (Carpentier-Edwards Physio 26-mm ring, Edwards Lifesciences, Irvine, California), and coronary artery bypass grafting was referred for evaluation of critical aortic valve (AV) stenosis and in-ring MV stenosis. Transesophageal echocardiogram demonstrated AV and MV area of 0.8 × 1.0 cm2, with mean gradients of 36 × 18 mm, respectively. Coronary catheterization demonstrated patent grafts. The Society of Thoracic Surgeons risk score was >6%, and thus transcatheter approach was considered.
Briefly, a temporary pacemaker wire was advanced into the right ventricular apex and a pig tail catheter into the right coronary cusp from right femoral access. A 6-cm left minithoracotomy was performed, left ventricular apical sutures were inserted, and a J wire was advanced into the descending aorta and was exchanged for an Amplatz wire (Boston Scientific, Marlborough, Massachusetts). A 26-F sheath was advanced into the left ventricular cavity followed by balloon aortic valvuloplasty (Figure 1, Online Video 1). An Edward Sapien XT 26-mm valve (Edwards Lifesciences) was deployed with 60% to the aortic side and 40% to the ventricular side (Figure 2, Online Video 2); this configuration was kept on purpose in preparation for MV prosthesis implantation. Repeat balloon aortic valvuloplasty was done. A Judkins right 4-F catheter was used to remove the Amplatz wire, and the catheter was pulled back into left ventricle and its tip pointed toward the MV. The C-arm was positioned so that the mitral prosthetic ring was perpendicular to the image. MV was crossed with the glide wire under transesophageal echocardiographic guidance (Figure 3, Online Video 3) and was exchanged for the Amplatz wire and prolapsed into the pulmonary vein (Figure 4, Online Video 4). Balloon mitral valvuloplasty was performed (Figure 5, Online Video 5). An Edwards Sapien XT 23-mm valve was deployed in the mitral position, 40% ventricular and 60% atrial configuration (Figures 6 and 7, Online Videos 6 and 7), and repeat balloon mitral valvuloplasty was done. Final intraoperative transesophageal echocardiography and 1-month interval 2-dimensional echocardiogram showed minimal aortic and mitral regurgitation.
Transcatheter transapical approach has been described (1–4); however, to the best of our knowledge, this is the first reported case of simultaneous transcatheter aortic and in-ring mitral valve implantation.
Dr. Morsli is a consultant for Arbor Pharmaceutical and Janssen Pharmaceutical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 11, 2015.
- Accepted March 2, 2015.
- 2015 American College of Cardiology Foundation
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