Key result
Valve-in-valve TAVR resolves functional mitral stenosis, cutting mean transmitral gradient by ~11 mm Hg.
Why the study?
Bioprosthetic aortic valve degeneration can present as isolated regurgitant failure with an eccentric jet that raises the transmitral gradient and mimics mitral stenosis.
Does transfemoral valve-in-valve transcatheter aortic valve replacement resolve severe functional mitral stenosis and reduce the transmitral gradient in a patient with severe eccentric aortic regurgitation from a degenerated bioprosthetic aortic valve?
Case Report (n=1)
Does transfemoral valve-in-valve transcatheter aortic valve replacement resolve severe functional mitral stenosis and reduce the transmitral gradient in a patient with severe eccentric aortic regurgitation from a degenerated bioprosthetic aortic valve?
Treating eccentric bioprosthetic aortic regurgitation with valve-in-valve TAVR can completely resolve functional mitral stenosis and elevated transmitral gradients without requiring direct mitral intervention.
Answers are grounded in this paper and cite their sources.
Addressing aortic regurgitation may normalize secondary mitral gradients without mitral intervention; leaves open generalizability beyond single cases.
BACKGROUND: Bioprosthetic aortic valve degeneration can present as isolated regurgitant failure, and an eccentric jet may raise the transmitral gradient, mimicking mitral stenosis. CASE SUMMARY: An 84-year-old man presented with acute heart failure 12 years after surgical aortic valve replacement. Echocardiography showed a degenerated Trifecta bioprosthesis with an immobile leaflet causing severe eccentric aortic regurgitation, whose jet impinged on the anterior mitral leaflet and produced severe functional mitral stenosis. Given high surgical risk, the heart team performed transfemoral valve-in-valve transcatheter aortic valve replacement. DISCUSSION: Trifecta leaflet tear causes regurgitant rather than stenotic failure; an eccentric jet can raise the transmitral gradient independent of the Austin Flint murmur. Valve-in-valve transcatheter aortic valve replacement eliminated the regurgitation, improved leaflet mobility, and reduced the mean mitral gradient from 17 to 6 mm Hg, with complete symptom resolution. TAKE-HOME MESSAGE: Eccentric aortic regurgitation can cause a reversible rise in transmitral gradient; treating it can resolve apparent mitral stenosis without mitral intervention.
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Ray et al. (2026) conducted a case report in Degenerated Trifecta bioprosthesis causing severe eccentric aortic regurgitation and functional mitral stenosis (n=1). Transfemoral valve-in-valve transcatheter aortic valve replacement (TAVR) was evaluated on Mean transmitral gradient (mm Hg). Valve-in-valve TAVR eliminated eccentric aortic regurgitation and reduced the mean transmitral gradient from 17 to 6 mm Hg, resolving functional mitral stenosis.
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