Valve re-tensioning successfully resolved severe paravalvular leakage and hemolytic anemia caused by late valve dislodgement following transcatheter mitral valve implantation.
Case Report (n=1)
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Does valve re-tensioning resolve hemolysis and paravalvular leakage in patients with late valve dislodgement after transcatheter mitral valve implantation?
Valve re-tensioning via prior thoracotomy can successfully manage severe paravalvular leakage and hemolysis caused by late valve dislodgement after transcatheter mitral valve implantation.
BACKGROUND: Transcatheter mitral valve implantation (TMVI) device featuring an apical fixation design is now the most mature TMVI system and widely applied in routine clinical practice. Nevertheless, severe unique complications including left ventricular outflow tract (LVOT) obstruction, paravalvular leakage (PVL), and hemolysis can still occur with this device. A 75-year-old frail elderly female with severe mitral regurgitation (MR) and recurrent heart failure was admitted to our institution for treatment. TMVI was successfully completed. The patient was subsequently rehospitalized owing to decompensated heart failure, PVL and severe hemolysis due to late valve dislodgement. We then performed valve re-tensioning via the prior thoracotomy, which resolved PVL and relieved hemolysis. DISCUSSION: Subacute dislodgement of the prosthesis can still occur following TMVI with apical fixation design, leading to severe PVL and hemolysis. Accurate diagnosis using transesophageal echocardiography (TEE) combined with prompt re-tensioning is critical for the management of this complication.
Wang et al. (Mon,) conducted a case report in Severe mitral regurgitation with post-TMVI hemolysis and paravalvular leakage (n=1). Valve re-tensioning was evaluated on Resolution of hemolysis and paravalvular leakage. Valve re-tensioning successfully resolved severe paravalvular leakage and hemolytic anemia caused by late valve dislodgement following transcatheter mitral valve implantation.