European Heart Journal Advance Access published May 20, 2015
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehv167
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First-in-man transapical mitral valve replacement using the Direct Flow Medicalw aortic valve prosthesis Fritz Mellert1†, Jan-Malte Sinning2†, Nikos Werner2, Armin Welz1, Eberhard Grube2, Georg Nickenig2*, and Christoph Hammerstingl2 1 Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany; and 2Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
* Corresponding author. Email: [email protected] †
F.M. and J.-M.S. contributed equally to the manuscript.
Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on October 23, 2015
A 74-year-old male presented with progressive dyspnoea NYHA functional class III –IV. Echocardiography revealed severe mitral valve (MV) stenosis with an MV area of 0.6 cm2 (Panel A) and an increase in systolic pulmonary artery pressure from 36 to 75 mmHg during exercise stress echocardiography. Multi-slice computed tomography (MSCT) showed a circumferential mitral annular calcification with involvement of both MV leaflets (Panel B, MSCT of MV annulus: perimeter 90.6 mm). Due to high surgical risk (STS score 6.8%) with a history of surgical aortic valve replacement and coronary artery bypass grafting in 2006, the Heart Team decided for transcatheter MV replacement (TMVR) via transapical access. A 26 mm balloon valvuloplasty catheter was used for predilation and sizing simultaneously to left ventriculography (Panels C and D, see Supplementary material online, Videos 1 and 2). Due to MV annulus size and shape, the non-metallic Direct Flow Medicalw (DFM) (Direct Flow Medical, Santa Rosa, CA, USA) valve was chosen and implanted transapically under transoesophageal echocardiographic (TEE) and fluoroscopic guidance with a pigtail catheter in the left ventricle to rule out relevant left ventricular outflow tract (LVOT) obstruction. This valve is repositionable and fully recapturable in case of LVOT obstruction or intolerable paravalvular leckage. 3D-TEE and fluoroscopy confirmed proper valve positioning with mild paravalvular mitral regurgitation (MR) after valve expansion (Panel E), without relevant residual stenosis or LVOT obstruction (Panel F, see Supplementary material online, Videos 3 and 4). After the procedure, the patient improved significantly (NYHA I-II). The case demonstrates that MV disease with severely calcified MV annulus may be treated by TMVR with a repositionable transcatheter aortic valve prosthesis in selected high risk patients.
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehv167
.............................................................................................................................................................................
First-in-man transapical mitral valve replacement using the Direct Flow Medicalw aortic valve prosthesis Fritz Mellert1†, Jan-Malte Sinning2†, Nikos Werner2, Armin Welz1, Eberhard Grube2, Georg Nickenig2*, and Christoph Hammerstingl2 1 Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany; and 2Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
* Corresponding author. Email: [email protected] †
F.M. and J.-M.S. contributed equally to the manuscript.
Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on October 23, 2015
A 74-year-old male presented with progressive dyspnoea NYHA functional class III –IV. Echocardiography revealed severe mitral valve (MV) stenosis with an MV area of 0.6 cm2 (Panel A) and an increase in systolic pulmonary artery pressure from 36 to 75 mmHg during exercise stress echocardiography. Multi-slice computed tomography (MSCT) showed a circumferential mitral annular calcification with involvement of both MV leaflets (Panel B, MSCT of MV annulus: perimeter 90.6 mm). Due to high surgical risk (STS score 6.8%) with a history of surgical aortic valve replacement and coronary artery bypass grafting in 2006, the Heart Team decided for transcatheter MV replacement (TMVR) via transapical access. A 26 mm balloon valvuloplasty catheter was used for predilation and sizing simultaneously to left ventriculography (Panels C and D, see Supplementary material online, Videos 1 and 2). Due to MV annulus size and shape, the non-metallic Direct Flow Medicalw (DFM) (Direct Flow Medical, Santa Rosa, CA, USA) valve was chosen and implanted transapically under transoesophageal echocardiographic (TEE) and fluoroscopic guidance with a pigtail catheter in the left ventricle to rule out relevant left ventricular outflow tract (LVOT) obstruction. This valve is repositionable and fully recapturable in case of LVOT obstruction or intolerable paravalvular leckage. 3D-TEE and fluoroscopy confirmed proper valve positioning with mild paravalvular mitral regurgitation (MR) after valve expansion (Panel E), without relevant residual stenosis or LVOT obstruction (Panel F, see Supplementary material online, Videos 3 and 4). After the procedure, the patient improved significantly (NYHA I-II). The case demonstrates that MV disease with severely calcified MV annulus may be treated by TMVR with a repositionable transcatheter aortic valve prosthesis in selected high risk patients.
