Transcatheter Mitral Valve Implantation (TMVI) Using Edwards SAPIEN 3 Prostheses in Patients at Very High or Prohibitive Surgical Risk: A Single-Center Experience

Figure 1

TMVI-MAC: (a) fluoroscopy shows a 0.035-inch J-guide inserted through the mitral valve in the left ventricle via a steerable guiding catheter (Agilis, 8,5F, Abbott, Illinois, USA). (b) Fluoroscopy shows balloon dilatation (Osypka VACS II 12 × 60 mm Balloon, Osypka AG, Germany, white arrow) of the interatrial septum over an Amplatz Super Stiff guidewire (Boston Scientific) to create an artificial atrial septum defect prior to insertion of the prosthesis into the left atrium. (c) Fluoroscopy shows the implantation of a 29 mm Edwards SAPIEN 3 (ES 3) prosthesis into the heavily calcified native mitral valve. (d) Fluoroscopy shows the final result after implantation of the ES 3 prosthesis into the calcified native mitral valve. (e) 3D-TEE shows the native mitral valve with a heavily calcified native mitral ring prior to TMVI (view from left atrium). (f) 3D-TEE shows the result after TMVI of the 29 mm ES 3 prosthesis into the advanced mitral annular calcification (MAC). (g) 2D-TEE with color duplex shows only minimal paravalvular and valvular regurgitation after implantation of the ES 3 Prosthesis into the MAC. (h) Cardiac CT-scan shows the exact dimensions of the calcified mitral valve prior to implantation. (i) Cardiac CT-scan shows the final result after TMVI into MAC. (j) 2D-TEE with color duplex shows a large iatrogenic atrial septal defect (ASD) with clinically relevant right-to-left cardiac shunt. (k) Fluoroscopy shows successful transcatheter implantation of an Amplatzer Septal Occluder (Abbott, Illinois, USA) into the ASD (white arrow).

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