Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings

Abstract

Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings. (Level of Difficulty: Intermediate.).

Keywords: LV, left ventricle; LVOT, left-ventricular outflow tract; MPR, multiplanar reconstruction; MR, mitral regurgitation; MV, mitral valve; Medtronic Mosaic; RV, right ventricle; S3, Edwards SAPIEN 3 valve; TEE, transesophageal echocardiography; TMVR, transcatheter mitral valve-in-valve replacement; TTE, transthoracic echocardiography; bioprosthetic valve dysfunction; mitral valve; transcatheter valve replacement.