Transapical Transcatheter Valve-in-Valve Implantation for Deteriorated Mitral Valve Bioprostheses Manuel Wilbring, MD, Konstantin Alexiou, MD, Sems Malte.

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Transapical Transcatheter Valve-in-Valve Implantation for Deteriorated Mitral Valve Bioprostheses Manuel Wilbring, MD, Konstantin Alexiou, MD, Sems Malte Tugtekin, MD, Bjoern Sill, MD, Peter Hammer, PhD, Torsten Schmidt, MD, Gregor Simonis, MD, Klaus Matschke, MD, Utz Kappert, MD The Annals of Thoracic Surgery Volume 95, Issue 1, Pages 111-117 (January 2013) DOI: 10.1016/j.athoracsur.2012.08.004 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Fluoroscopy sequence of transcatheter mitral valve-in-valve implantation in (A) a patient with prior aortic and mitral valve replacement. (B) The guidewire is placed through the mitral valve bioprosthesis and the Edwards SAPIEN valve subsequently delivered. After (C) slow and gradual expansion, (D) the SAPIEN valve is sufficiently anchored. The Annals of Thoracic Surgery 2013 95, 111-117DOI: (10.1016/j.athoracsur.2012.08.004) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transesophageal echocardiography demonstrating implantation sequence of transcatheter mitral valve-in-valve implantation. (A) Two-dimensional echocardiography of the degenerated mitral valve bioprosthesis. The mechanism of failure was leaflet prolapse (*), (B) leading to severe regurgitation. After implantation of the SAPIEN valve, the prosthesis shows good anchorage with (C) full opening and (D) sufficient closure. The Annals of Thoracic Surgery 2013 95, 111-117DOI: (10.1016/j.athoracsur.2012.08.004) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions