Prosthetic Heart Valve Interactions and Their Clinical Significance During Transcatheter Left-Sided Double Valve Replacement

Figures

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  Figure 1. Case 1: Simultaneous TAVI With a 23-mm Myval Valve and M-ViV With a 24.5-mm Myval Valve Inside a 27-mm Biocor Valve With Favorable Lateral Anterior Mitral Posts (A to C) Positioning and deployment of the 23 mm TAV at the aortic position. The 27 mm Bicor mitral valve sewing ring alone is faintly seen in the enface view below the aortic valve. (D to F) Positioning and deployment of the 24.5 mm TMV inside the 27 mm Biocor mitral valve without interaction with the TAV. M-ViV = mitral valve-in-valve implantation; TAV = transcatheter aortic valve; TAVI = transcatheter aortic valve implantation; TMV = transcatheter mitral valve.

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  Figure 2. Case 2: Simultaneous TAVI With a 21.5-mm Octacor Valve and M-ViV With a 23-mm Myval Valve Inside a 25-mm Mosaic Valve With an Unfavorable Central Anterior Post (A) A 21.5-mm Meril Myval valve at the aortic position. At the beginning of inflation, the eye of the central anterior post is seen in the coplanar view (arrow and inset). (B) During full inflation of the balloon, the eye of the anterior post is seen in the enface view, suggesting significant bending of the post. (C) After deflation of the balloon, the aortic Octacor valve was deployed and the recovery of the Mosaic anterior post is shown (back to coplanar). (D) A 23-mm Myval valve was deployed inside the Mosaic mitral valve and did not show any interaction with the aortic Octacor valve. (E and F) The relation of the 2 transcatheter valves in the cusp overlap view and the mitral enface view. M-ViV = mitral valve-in-valve implantation; TAVI = transcatheter aortic valve implantation.

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  Figure 3. Case 3: Simultaneous TAVI With a 29-mm Myval Valve and M-ViV With a 27.5-mm Myval Valve Inside a 27-mm Perimount Mitral Valve With Favorable Posts (A) A 29-mm Meril Myval valve at the aortic position. At the beginning of inflation, the TAVI system fits between the lateral anterior posts without interaction. (B) During full inflation of the balloon, mild stretching of the anterior posts was seen. (C) After deflation of the balloon, the aortic Myval valve was deployed and the normal anterior mitral posts are shown. The two arrows in A to C indicate the favourable lateral anterior posts of bioprosthetic mitral valve on either side of the left ventricular outflow tract. (D and E) A 27.5-mm Myval valve was deployed inside the 27-mm Perimount mitral valve and did not show any interaction with the aortic Myval valve. (F) The relation of the 2 transcatheter valves. M-ViV = mitral valve-in-valve implantation; TAVI = transcatheter aortic valve implantation.

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  Visual Summary. Strategy to Minimize the Prosthetic Heart Valve Interactions During Transcatheter Double Valve Replacement TAVI first with a preexisting BPMV either ends in type-M1 interaction with favorable lateral anterior BPMV posts position or type-M2 interaction with an unfavorable central anterior BPMV post. M-ViV after TAVI did not create any interactions. Type-M1 reversible stretching of the favorable lateral anterior posts by the TAV balloon. Type-M2 reversible bending of the unfavorable central anterior post by the TAV balloon. BPMV = bioprosthetic mitral valve; DVR = double valve replacement; M-ViV = mitral valve-in-valve; TAV = transcatheter aortic valve; TAVI= transcatheter aortic valve implantation; TMV = transcatheter mitral valve.