Transjugular Approach in Valve-in-Valve Transcatheter Mitral Valve Replacement: Direct Route to the Valve Tsuyoshi Kaneko, MD, JaBaris D. Swain, MD,

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Transjugular Approach in Valve-in-Valve Transcatheter Mitral Valve Replacement: Direct Route to the Valve Tsuyoshi Kaneko, MD, JaBaris D. Swain, MD, Dan Loberman, MD, Frederick G.P. Welt, MD, Michael J. Davidson, MD, Andrew C. Eisenhauer, MD The Annals of Thoracic Surgery Volume 97, Issue 6, Pages e161-e163 (June 2014) DOI: 10.1016/j.athoracsur.2014.01.068 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transjugular–transseptal approach. Sheath is going through the atrial septum and mitral valve, which allows better and accurate control of the valve. The Annals of Thoracic Surgery 2014 97, e161-e163DOI: (10.1016/j.athoracsur.2014.01.068) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 After valve deployment. New valve is positioned inside the previous valve. The Annals of Thoracic Surgery 2014 97, e161-e163DOI: (10.1016/j.athoracsur.2014.01.068) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Transesophageal echocardiogram after implantation showing a well-seated valve with no paravalvular leak. (Top panel) Without Doppler. (Bottom panel) With Doppler. The Annals of Thoracic Surgery 2014 97, e161-e163DOI: (10.1016/j.athoracsur.2014.01.068) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions