Abstract
Left ventricular outflow tract (LVOT) obstruction is a recognized complication of transcatheter mitral valve-in-valve replacement in previous surgical prostheses. We describe a patient who was high risk for repeat open surgery in whom the LVOT was compromised by a surgical strut and the potential for LVOT obstruction. A novel approach to avoiding this complication was utilized. A perfusion balloon was inflated in the outflow tract to provide an opposing force during mitral valve deployment resulting in less flaring of the strut into the outflow tract thereby improving the neo-LVOT area. No outflow tract obstruction occurred. The advantages of this approach as well as other alternative solutions to this problem are discussed. © 2017 Wiley Periodicals, Inc.
Keywords:
hemodynamics; interventional devices/innovation; mitral valve disease; percutaneous intervention; transcatheter valve implantation.
© 2017 Wiley Periodicals, Inc.
MeSH terms
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Aged, 80 and over
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Balloon Valvuloplasty / adverse effects
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Balloon Valvuloplasty / methods*
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Bioprosthesis*
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Cardiac Catheterization / adverse effects
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Cardiac Catheterization / instrumentation*
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Cardiac Catheterization / methods
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Computed Tomography Angiography
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Echocardiography, Doppler
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Echocardiography, Three-Dimensional
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Female
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Heart Valve Prosthesis Implantation / adverse effects
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Heart Valve Prosthesis Implantation / instrumentation*
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Heart Valve Prosthesis Implantation / methods
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Heart Valve Prosthesis*
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Hemodynamics
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Humans
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Mitral Valve / diagnostic imaging
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Mitral Valve / physiopathology
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Mitral Valve / surgery*
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Mitral Valve Stenosis / diagnostic imaging
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Mitral Valve Stenosis / physiopathology
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Mitral Valve Stenosis / surgery*
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Prosthesis Design
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Recovery of Function
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Treatment Outcome
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Ventricular Outflow Obstruction / etiology
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Ventricular Outflow Obstruction / physiopathology
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Ventricular Outflow Obstruction / prevention & control*