Hemolysis After Transcatheter Mitral Valve Implantation Resolved by Valve Retensioning

Figure 1. Baseline Mitral Valve Anatomy (A) 3-dimensional view of the mitral valve from the left atrium showing focal calcifications of the anterior and posterior valve leaflets (arrows) precluding transcatheter edge-to-edge repair. (B) 3-dimensional Doppler view showing an eccentric severe mitral regurgitation jet originating from the calcified zone of both leaflets.

Figure 2. Pre-Procedural Transcatheter Mitral Valve Implantation Planning (A) Systolic measurement of neo–left ventricular outflow tract area (green) after delineation of the mitral valve (MV) annulus and simulation of the 35-mm (M) low-profile Tendyne valve (blue). (B) Interaction between Tendyne valve stent frame, MV calcifications, and aortic bioprosthesis. (C) Simulation of the Tendyne valve and tether during diastole (blue) and systole (pink).

Figure 3. Valve Implantation Procedure (A) 2-chamber view of the Tendyne valve during implantation showing annular apposition of the D-shaped atrial stent frame. (B) Left ventricular outflow tract (LVOT) view of the Tendyne valve obtained using the x-plane function. (C) Acute LVOT obstruction during valve implantation with imminent circulatory arrest. (D) Anterior paravalvular leak (arrow) at the end of the procedure with resolved LVOT obstruction. IVS = interventricular septum.

Figure 4. Evolution of Hemodynamic Parameters During Tendyne Valve Implantation ABP (s/m/d) = arterial blood pressure (systolic/mean/diastolic); CVP = central venous pressure; LVOTO = left ventricular outflow tract obstruction; pCO2 = carbon dioxide pressure.

Figure 5. Evolution of Hemoglobin and Hemolytic Parameters During Therapy Hb = hemoglobin; LDH = lactate dehydrogenase; TMVI = transcatheter mitral valve implantation.

Figure 6. Valve Retensioning Procedure (A) Left ventricular outflow tract (LVOT) view of the Tendyne valve showing worsening paravalvular leak (PVL) (arrow) due to valve loosening. (B) Improved apposition of the valve after successful retensioning with PVL abolishment and open LVOT. IVS = interventricular septum.