Open-heart transseptal transcatheter mitral valve implantation with mitral annular calcification

Shohei Morita; Shinya Takahashi; Mathieu Pernot; Lionel Leroux; Louis Labrousse

doi:10.1016/j.jccase.2020.06.017

Open-heart transseptal transcatheter mitral valve implantation with mitral annular calcification

J Cardiol Cases. 2020 Jul 18;22(5):207-209. doi: 10.1016/j.jccase.2020.06.017. eCollection 2020 Nov.

Authors

Shohei Morita¹, Shinya Takahashi¹, Mathieu Pernot², Lionel Leroux², Louis Labrousse²

Affiliations

¹ Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.
² Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, Bordeaux, France.

Abstract

Mitral valve replacement (MVR) using a prosthesis of transcatheter aortic valve implantation for mitral annular calcification (MAC) is an alternative procedure which is very different from a conventional MVR and is safe. Acceptable results including mortality and morbidity have been reported. We report the case of a male patient treated with this procedure. There was a risk of left ventricular rupture due to extensive decalcification, so we performed transcatheter mitral valve implantation (TMVI). Since he had a history of surgical aortic valve replacement (AVR), we chose open-heart transseptal approach so as not to interfere with the aortic prosthesis. TMVI has a risk of an iatrogenic left ventricular outflow tract (LVOT) obstruction. Using open-heart transseptal approach, we could easily check an anterior commissure of mitral annulus to prevent LVOT obstruction. <Learning objective: Transcatheter mitral valve implantation (TMVI) using a transcatheter aortic prosthesis is safe for mitral valve disease with mitral annular calcifications. This patient had a history of surgical aortic valve replacement, so we performed open-heart transseptal TMVI to prevent interference with the aortic prosthesis and the iatrogenic left ventricular outflow tract obstruction.>.

Keywords: Left ventricular outflow tract obstruction; Mitral annular calcification; Mitral valve replacement; Sapien 3; Transcatheter mitral valve implantation; Transseptal approach.