Abstract Background Ring annuloplasty failure after mitral valve repair is frequently happened after long-term follow up. Valve-in-ring transcatheter mitral valve replacement (TMVR) is emerging therapeutic option for this high surgical risk condition. While dual-chamber ICD is frequently utilised for sudden cardiac death prevention in this population, valve-in-ring TMVR intraprocedural difficulty associated with atrial lead presence is rarely known. Case Summary A 76 years-old-male, with history of CABG and mitral ring annuloplasty experienced recurrence of severe MR. Due to high surgical mortality risk and unsuitable anatomy of mitral valve for TEER, this patient underwent mitral valve-in-ring TMVR. Using transvenous-transseptal access, 26 mm SAPIEN-3 prosthetic valve was delivered to mitral area. However, as the patient has a history of dual chamber ICD, prosthetic valve cannot pass through during delivery, due to atrial lead entanglement. To overcome this difficulty, atrial septum balloon dilatation maneuver was done to facilitate valve delivery which resulted in successful prosthetic valve delivery and deployment at mitral position with satisfactory results. Discussion Valve delivery difficulty due to atrial lead entanglement can occur during valve-in-ring TMVR in patient with dual-chamber ICD implantation history. Atrial septum balloon dilatation can be performed to overcome this problem.
Hutomo et al. (Sun,) studied this question.