Radiofrequency Ablation for Prevention of Outflow Tract Obstruction in Percutaneous Mitral Valve-in-Valve Replacement

Figures

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  Figure 1. TTE Parasternal Long-Axis View Pre-Mitral ViV Procedure Septal thickness 1.37 cm. TTE = transthoracic echocardiogram; ViV = valve-in-valve.

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  Figure 2. CTA Chest for Preprocedural Planning Mitral ViV Measurements and Post-RFA for Reassessment of neoLVOT (A) Estimated neoLVOT at 30% systolic phase, using a 26-mm valve, of 149 mm2, short prosthesis to septal distance, and unfavorable aorto-mitral angle. (B) Enlargement of neoLVOT at 40% systolic phase to 232 mm2. CTA = computed tomography angiography; LVOT = left ventricular outflow tract; RFA = radiofrequency ablation; other abbreviation as in Figure 1.

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  Figure 3. Septal Ablation Mapping Right anterior oblique view of electro-anatomic mapping demonstrating distance of 5.5 mm between ablation and bundle of His. Purple, red, and yellow circles represent bundle branch potentials, area of ablation, and bundle of His potentials, respectively.

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  Figure 4. Multiplanar Image Assessment of neoLVOT Virtual Sapien 3 26-mm valve modeled and offset at the level of surgical valve post. Abbreviations as in Figure 2.

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  Figure 5. TEE Post Mitral ViV Peak transmitral velocity 1.4 m/s and mean gradient across valve 2 mm Hg. TEE = transesophageal echocardiography; other abbreviation as in Figure 1.

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  Figure 6. TTE Post Mitral ViV Abbreviations as in Figure 1.