Salvage Transcatheter Mitral Valve-in-Valve With Aspiration Thrombectomy in a Young Adult With Repaired CHD

Prosthetic mitral valve degeneration in adults with repaired congenital heart disease (CHD) can produce rapid hemodynamic collapse and is challenging when surgery and mechanical circulatory support (MCS) are unavailable. A 20-year-old woman with congenital mitral stenosis and multiple ventricular septal defects initially palliated as a single ventricle, then converted to biventricular circulation, with prior mechanical and bioprosthetic mitral valve replacements (the latter for menorrhagia, outside our care), presented in cardiogenic shock with prosthetic mitral stenosis and acute left atrial thrombus. Hypoplastic peripheral vessels precluded MCS. Salvage valve-in-valve was performed with bilateral cerebral protection, FlowTriever thrombectomy (Inari Medical), and a 26-mm SAPIEN 3 valve (Edwards Lifesciences). Transcatheter mitral valve-in-valve can be lifesaving in adults with repaired CHD when intracardiac thrombus is present, and MCS is unavailable. In highly selected, life-threatening presentations without alternatives, salvage transcatheter mitral intervention may be considered despite intracardiac thrombus. Peripheral vascular anatomy must be evaluated preprocedurally in complex CHD.