Case report demonstrates endovascular repair of venous perforation in a heart failure patient, suggesting vital interventions for complications.
Background Transcatheter mitral valve-in-valve (TMViV) replacement via trans-septal access is a less invasive alternative for high-risk patients with degenerated bioprosthetic valves. However, life-threatening venous injuries may occur, though they are rarely reported. Case Summary A 73-year-old man with a prior mitral bioprosthetic valve replacement presented with heart failure due to severe prosthetic stenosis. TMViV was planned via a trans-septal approach. During device advancement through the right iliac vein, a massive venous perforation occurred, resulting in hemorrhagic shock. The cause was likely unrecognized venous calcification. Emergent endovascular repair with covered stents successfully stabilized the patient. Discussion This case highlights the risk of catastrophic venous complications during trans-septal TMViV procedures, particularly in patients with venous calcification. Prompt recognition and endovascular intervention can be life-saving in such rare but critical scenarios.
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Kao et al. (2025) studied this question.
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