Urgent transapical mitral valve-in-valve implantation successfully restored effective valve function and hemodynamic stability in an 84-year-old woman with acute bioprosthetic failure and prohibitive surgical risk.
Case Report (n=1)
No
This case highlights the presentation and diagnostic imaging of acute leaflet disruption in a degenerated mitral bioprosthesis requiring urgent transapical valve-in-valve implantation.
An 84-year-old woman with a history of surgical mitral valve replacement in 2015 using a 25mm Hancock II porcine bioprosthesis, combined with left atrial appendage closure and tricuspid valve repair (De Vega technique) performed via median sternotomy, was admitted with rapidly progressive dyspnea, orthopnea, and acute decompensated heart failure.Her comorbidities included heart failure with preserved ejection fraction, permanent atrial fibrillation, chronic kidney disease (estimated glomerular filtration rate 29 ml/min/1.73m 2 ), chronic obstructive pulmonary disease, and arterial hypertension.On admission, she required intravenous diuretics and oxygen therapy.Inflammatory markers remained within normal range and repeated blood cultures were negative, reducing the likelihood of infective endocarditis.Transesophageal echocardiography did not show features suggestive of infective endocarditis, such as vegetations or abscess formation, making an infectious etiology unlikely.Transthoracic and transesophageal echocardiography demonstrated degeneration of the mitral bioprosthesis with leaflet disruption consistent with structural valve deterioration, resulting in torrential mitral regurgitation with an effective regurgitant orifice area of 0.5 cm 2
Jodłowski et al. (Wed,) conducted a case report in Acute leaflet disruption of a degenerated mitral bioprosthesis (n=1). Transapical mitral valve-in-valve implantation (Edwards SAPIEN 3) was evaluated on Hemodynamic stabilization and reduction of mitral regurgitation. Urgent transapical mitral valve-in-valve implantation successfully restored effective valve function and hemodynamic stability in an 84-year-old woman with acute bioprosthetic failure and prohibitive surgical risk.