Acute Severe Mitral Stenosis Immediately After Transcatheter Aortic Valve Implantation

J INVASIVE CARDIOL 2017;29(10):E154.

Key words: transcatheter aortic valve replacement, complication, mitral stenosis, surgery

An 86-year-old female patient was referred for treatment of symptomatic severe aortic stenosis. The heart team decided to perform transfemoral transcatheter aortic valve implantation. A 25 mm Portico transcatheter aortic valve (St. Jude Medical) was implanted, but the valve migrated low into the left ventricular outflow tract (Figures 1A and 1B; Video 1). All repositioning and retrieval attempts were unsuccessful. The patient had only mild aortic regurgitation; however, she rapidly developed signs and symptoms of heart failure. An intraprocedural transesophageal echocardiogram demonstrated a restricted diastolic opening of the anterior mitral leaflet as a result of the low-placed Portico valve that led to severe mitral stenosis¹ with a mean gradient of 11 mm Hg (Figures 1C-1E). Subsequently, the patient underwent urgent aortic valve replacement surgery with removal of the Portico valve and replacement with a 21 mm Perimount Magna bioprosthesis (Edwards Lifesciences). The patient had an uneventful postoperative recovery and was discharged 1 week after surgery.

Reference

1.    Franco E, de Agustín JA, Hernandez-Antolin R, et al. Acute mitral stenosis after transcatheter aortic valve implantation. J Am Coll Cardiol. 2012;60:e35.

From the ¹Department of Cardiology and Intensive Care, St. Josef Hospital Braunau, Austria; ²Department of Cardiology, Kepler University of Medicine Linz, Austria; ³Department of Cardiac Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; and ⁴HerzReha Bad Ischl, Bad Ischl, Austria.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted April 13, 2017.

Address for correspondence: Johann Auer, MD, FESC, FACC, Department of Cardiology and Intensive Care, St. Josef Hospital Braunau, Ringstrasse 60, 5280 Braunau, Austria. Email: johann.auer@khbr.at