Technical challenges to a successful valve-in-valve Transcatheter Mitral Valve Implantation (TMVI)

Mitral valve disease is more common than Aortic valve stenosis in the developing world. Surgical approach has remained the gold standard in management of degenerative and failed bioprosthetic Mitral Valve Regurgitation (MR). However, with the success of Transcatheter Aortic Valve Implantations (TAVI), the percutaneous replacement of a diseased Mitral Valve (MV) is also becoming a viable option in select patients. One of the main challenges during TMVI is the location of transseptal puncture and manipulation of delivery catheter with highflexure capabilities to reach the mitral valve. These problems are only compounded when dealing with degenerated bioprosthetic mitral valves of various types. Here we present a case of valve-in-valve TMVI done, surmounting all technical challenges, resulting in excellent clinical outcome.