Mitral valve injury late after transcatheter aortic valve implantation

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Mitral valve injury late after transcatheter aortic valve implantation Daniel R. Wong, MD, MPH, Robert H. Boone, MD, MSc, Christopher R. Thompson, MD, Michael F. Allard, MD, Lukas Altwegg, MD, Ronald G. Carere, MD, Anson Cheung, MD, Jian Ye, MD, Samuel V. Lichtenstein, MD, PhD, Hilton Ling, MD, John G. Webb, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 6, Pages 1547-1549 (June 2009) DOI: 10.1016/j.jtcvs.2008.06.018 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Transesophageal echocardiographic evaluation of late severe mitral regurgitation. A, Two regurgitant jets were identified, one transvalvular (arrow) and a second through a perforation in the anterior mitral leaflet (arrowhead). B, A ruptured aneurysm (arrow) of the anterior leaflet of the mitral valve was present adjacent to the ventricular edge (arrowhead) of the implanted transcatheter aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1547-1549DOI: (10.1016/j.jtcvs.2008.06.018) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Infective endocarditis on the transcatheter aortic valve. A, Intraoperative view from the surgeon's perspective; the right side of the image is anterior, corresponding to a “right” transcatheter valve cusp in nearly standard orientation. B, Explanted transcatheter valve as seen from the aortic side in the same orientation as above. The cusps appeared thickened and covered with nodular endocarditic excrescences; the “noncoronary” portion of the valve stent (arrow) was deformed by the surgeon to facilitate explantation. The stent was crushed to explant it and reformed ex vivo, but the effects of surgical removal were still apparent. C, Explanted transcatheter valve as seen from the ventricular side showing similar features. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1547-1549DOI: (10.1016/j.jtcvs.2008.06.018) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Representative light micrograph of percutaneous aortic valve cuspal tissue showing acutely inflamed vegetational material on the cusp surface (asterisk) with superficial permeation of cuspal tissue by inflammatory cells (arrow; A) and coccal bacteria within tissue planes of the cusp (double arrow; B). A, Hematoxylin and eosin stain; B, Gram stain. Bar is representative of 100 μm in each image. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1547-1549DOI: (10.1016/j.jtcvs.2008.06.018) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions