TITLE:
Successful Tavi in Patients with Previous Mitral Valve Replacement
AUTHORS:
Matjaz Bunc, Jana Ambrozic, Spela Music, Nikola Lakic, P. Berden, Rok Zbacnik
KEYWORDS:
TAVI; Mitral Valve Replacement; Aortic Prosthesis; Mitral Prosthesis
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.7,
December
31,
2012
ABSTRACT: Background: Transcatheter aortic valve implantation (TAVI) is a
new method for patients with severe aortic stenosis at high surgical risk, such
as previous cardiac surgery. The presence of mechanical mitral prosthesis might
complicate TAVI because of possible interference between both prostheses. Some
reports have already demonstrated the feasibility of TAVI in such patients. Case Reports: We report 2 patients with severe symptomatic aortic
stenosis who had prior mitral valve replacement that successfully underwent
TAVI with Edwards Sapien and CoreValve aortic prosthesis, re- spectively. Computed
tomographic angiography (CTA) was
useful for the assessment of the distance between both aor- tic and mitral
prosthesis annuli. Transesophageal echocardiography was crucial for precise
positioning of TAV. There were no special technical tips besides precise
positioning of the valve prosthesis. In case of Core Valve the goal was the
positioning at “zero point” and in case of Edwards Sapien valve a
“half-on-half” position according to natural aortic valve. We observed no
deformation or dysfunction of aortic and mitral prosthesis in any of the
patients. Balloon valvu- loplasty prior to implantation helps to observe the
mutual effect of the new aortic valve and pre-existent mitral prosthe- sis. Conclusions: We conclude that TAVI can be
safely and successfully performed in patients with mechanical mitral prosthesis
carefully considering the altered anatomical conditions. Skillfulness and TAVI
experience of the operators should not be neglected.