Valve-in-Mitral Annular Calcification Transcatheter Mitral Valve Replacement After Thrombosis of Extracardiac Valved Conduit

Figures

• 

  Figure 1. Cardiac Computed Tomography (A) Computed tomography volume rendering after surgical construction of a left atrium—left ventricle conduit. (B) Thrombosed valved left atrium–left ventricle conduit. LAA = left atrial appendage.

• 

  Figure 2. Baseline Transesophageal Echocardiography (A) Hemodynamic profile of native mitral valve demonstrating severe mitral stenosis and mild mitral regurgitation. (B) Three-dimensional echocardiography of severely calcified mitral annulus with reduced orifice area.

• 

  Figure 3. Pre-Procedural Computed Tomography for TMVR Planning (A) Circumferential mitral annular calcification (MAC) with CT-based MAC score of 9. (BandC) Predicted neo-left ventricular outflow tract (LVOT) using CT postprocessing modeling software.

• 

  Figure 4. Transcatheter Mitral Valve Replacement Procedure (A) Leaflet transversal and snaring. (B) Positioning of bend in Astato wire at leaflet base. (C) Post-leaflet laceration. (D) Edwards Sapien Ultra valve deployment in mitral position.

• 

  Figure 5. Intraprocedural Transesophageal Echocardiography (A) Two-chamber view showing no transvalvular/trivial perivalvular leak. (B) Three-dimensional view showing Edwards Sapien Ultra valve in mitral position.

• 

  Figure 6. Invasive Hemodynamics (A) Pulmonary arterial pressure (PA) 106/33/62 mm Hg before transcatheter mitral valve replacement (TMVR). (B) PA 72/27/42 mm Hg after TMVR.