A Rare Case of Radiation-Associated Aortic and Mitral Valve Stenosis Treated With Transcatheter Valve Replacements

Figures

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  Figure 1. Index Electrocardiography The index electrocardiogram revealed sinus rhythm with left atrial enlargement, left ventricular hypertrophy, right-axis deviation, and no significant conduction abnormalities.

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  Figure 2. Index Transthoracic Echocardiography Parasternal long-axis view showing calcification of the aortic and mitral valves with the hallmark feature of extension to the aortomitral curtain (arrows), consistent with radiation-associated valve disease.

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  Figure 3. Cardiac Computed Tomography (A) Multiplanar reconstruction demonstrating severe calcification of the aortic and mitral valves with concomitant aortomitral curtain calcification. (B) Multiplanar reconstruction of left ventricular outflow tract (LVOT) dimension in short-axis view is important to position the mitral valve and minimize the risk of developing an outflow tract gradient. The interventional team deployed the transcatheter aortic valve replacement because the struts of the transcatheter mitral valve replacement may land within the LVOT. LA = left atrium; LV = left ventricle; RV = right ventricle.

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  Figure 4. Cardiac Computed Tomography Volume-rendering 3-dimensional reconstruction with the use of cardiac computed tomography demonstrating aortomitral calcification.

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  Figure 5. Pre-Implantation Transesophageal Echocardiography (A) Multiplanar imaging of the mitral valve revealed a mitral valve area of 1.0 cm2 by 3-dimensional planimetry. There is heavy calcification of the annulus, leaflets, and aortomitral curtain. (B) Multiplanar imaging of the aortic valve shows a trileaflet valve with severe cusp calcification, consistent with transthoracic echocardiography finding of severe aortic stenosis.

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  Figure 6. Postimplantation Fluoroscopy Transcatheter atrial valve replacement and off-label transcatheter mitral valve replacement deployed via a transapical approach using a transcatheter heart valve in both positions.