Author + information
- Received March 7, 2018
- Revision received May 7, 2018
- Accepted May 15, 2018
- Published online October 1, 2018.
- Dariusz Jagielak, MD, PhDa,
- Dariusz Ciecwierz, MD, PhDb,
- Jadwiga Fijalkowska, MDc and
- Marcin Fijalkowski, MD, PhDb,∗ ()
- aDepartment of Cardiosurgery, Medical University of Gdansk, Gdansk, Poland
- bDepartment of Cardiology, Medical University of Gdansk, Gdansk, Poland
- cDepartment of Radiology, Medical University of Gdansk, Gdansk, Poland
- ↵∗Address for correspondence:
Dr. Marcin Fijalkowski, First Department of Cardiology, Medical University of Gdansk, M. Skłodowskiej-Curie 3a Street, 80-210 Gdansk, Poland.
The transcatheter mitral valve-in-ring (VIR) procedure can trigger more than just left ventricular outflow tract obstruction from permanent displacement of the native anterior mitral leaflet (1). A 74-year-old man was referred for VIR after pulmonary edema due to severe mitral regurgitation. Four years before, he underwent mitral valve repair with a 32-mm Carpentier-Edwards Annuloplasty Ring (Edwards Lifesciences, Irvine, California) and edge-to-edge commissural stitch. Baseline transesophageal echocardiography (TEE) was used to measure the mitral ring diameters and the length of the anterior leaflet (34 mm) (Figures 1A to 1C, Online Videos 1 and 2). We performed a transcatheter VIR procedure with a 29-mm Edwards Sapien 3 valve (Edwards Lifesciences). After implantation, intraoperative TEE revealed severe central mitral regurgitation secondary to a prolapsing native anterior leaflet into the S3 and mild paravalvular leaks (Figures 1D and 1E, Online Videos 3 and 4). After discharge, patient remained symptomatic, and several weeks later, we decided to surgically remove the anterior prolapsing mitral leaflet by an aortic approach. The patient subsequently improved and has remained asymptomatic (Figure 1F, Online Videos 5 and 6). Pre-procedural measurement of mitral leaflet length is important, and in cases with prolapse or long leaflets, VIR should not be performed without a strategy for the anterior leaflet modification such as removal or reduction (2).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2018.
- Revision received May 7, 2018.
- Accepted May 15, 2018.
- 2018 American College of Cardiology Foundation