Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe bioprosthetic mitral valve dysfunction and cardiogenic shock (n=1). Intervention: Transseptal valve-in-valve transcatheter mitral valve replacement guided by multimodality imaging.

Q: What does this research mean for the field?

Multimodality imaging including cardiac CT distinguishes structural valve degeneration from thrombosis to guide successful valve-in-valve transcatheter mitral valve replacement in high-risk patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Michael J McKenna; Conor McCaughey; Greg L Douglas; Charles J. McCreery; Niall T. Mulvihill; Martin Quinn; James A Shand

doi:10.1016/j.jaccas.2026.110750

October 16, 2026

Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR.

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Key result

Multimodality imaging differentiates bioprosthetic failure mechanisms to guide successful valve-in-valve TMVR in cardiogenic shock.

n=1

Graphical abstract published by the journal — Graphical abstract · Published by the journal · CC BY-NC-ND 4.0

Why the study?

Severe bioprosthetic valve dysfunction is diagnostically challenging because echocardiography alone may not distinguish reversible leaflet thrombosis from structural valve degeneration.

Key Points

To describe the use of multimodality imaging in differentiating structural valve degeneration from reversible leaflet thrombosis and directing transcatheter valve-in-valve therapy.
Evaluated a patient with end-stage renal disease, prior bioprosthetic mitral and aortic valve replacements, and cardiogenic shock using echocardiography and cardiac computed tomography.
Administered empiric intravenous unfractionated heparin for suspected thrombosis before performing definitive transseptal valve-in-valve transcatheter mitral valve replacement.
Cardiac computed tomography ruled out hypoattenuated leaflet thickening and confirmed severe leaflet calcification, establishing structural valve degeneration rather than leaflet thrombosis.
Transseptal valve-in-valve transcatheter mitral valve replacement produced rapid hemodynamic stabilization and clinical recovery.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A single patient with end-stage renal disease and previous bioprosthetic valve replacements presenting with severe bioprosthetic mitral valve dysfunction and cardiogenic shock.

I

Intervention

Cardiac computed tomography followed by transseptal valve-in-valve transcatheter mitral valve replacement (TMVR)

O

Outcome

Hemodynamic and clinical recovery

Cardiac computed tomography is effective in differentiating structural valve degeneration from leaflet thrombosis, guiding definitive treatment with transseptal valve-in-valve TMVR in high-surgical-risk patients.

Implication

May support cardiac CT to distinguish structural valve degeneration from thrombosis; hypothesis-generating for multimodality imaging-guided TMVR in cardiogenic shock.

Abstract

BACKGROUND: Severe bioprosthetic valve dysfunction presents a diagnostic challenge because distinguishing reversible leaflet thrombosis from structural valve degeneration may not be possible using echocardiography alone. CASE SUMMARY: A patient with end-stage renal disease, previous bioprosthetic mitral and aortic valve replacement, and prior valve-in-valve transcatheter aortic valve replacement presented with heart failure and cardiogenic shock. Multimodality imaging demonstrated severe bioprosthetic mitral valve dysfunction with restricted leaflet motion, raising suspicion for leaflet thrombosis. Empiric intravenous unfractionated heparin was commenced while cardiac computed tomography was arranged. Computed tomography excluded hypoattenuated leaflet thickening and demonstrated severe leaflet calcification, confirming structural valve degeneration. After heart team discussion, transseptal valve-in-valve mitral replacement resulted in rapid hemodynamic and clinical recovery. DISCUSSION: Serial multimodality imaging guided escalation from anticoagulation to definitive valve intervention. TAKE-HOME MESSAGES: Persistent prosthetic valve dysfunction after anticoagulation should prompt reassessment for structural valve degeneration. Transseptal valve-in-valve transcatheter mitral valve replacement is an effective treatment for selected high-surgical-risk patients.

Discussion

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Cite This Study

McKenna et al. (2026) conducted a case report in Severe bioprosthetic mitral valve dysfunction and cardiogenic shock (n=1). Transseptal valve-in-valve transcatheter mitral valve replacement guided by multimodality imaging was evaluated. Multimodality imaging including cardiac CT successfully distinguished structural valve degeneration from thrombosis in a patient with cardiogenic shock, guiding successful valve-in-valve TMVR.

synapsesocial.com/papers/6ad34dec727baf805bb60f50 https://doi.org/10.1016/j.jaccas.2026.110750

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Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR.

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR.

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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