Transcatheter trans-septal mitral valve-in-valve implantation

Our patient is 74-year-old man with a history of hypertension, hyperlipidemia, prior stroke, paroxysmal atrial fibrillation (on anticoagulation) who had a prior bioprosthetic mitral valve replacement (#33 St. Jude Medical Epic), tricuspid valve repair (#34 Contour Ring) who was doing well until 2 months prior to presentation when he noted increasing shortness of breath with exertion, lower extremity edema and weight gain. His symptoms progressed despite diuresis. On transthoracic echocardiography, he was noted to have depressed left ventricular (LV) function (ejection fraction 45%) and moderate to severe mitral regurgitation of his bioprosthetic mitral valve. His Society of Thoracic Surgeons (STS) score for a re-operative surgical mitral valve replacement was 6.2%. He was evaluated by our heart team and the decision was made to move forward with a transcatheter mitral valve replacement